Randomized Controlled Trials of Psilocybin-Assisted Therapy in the Treatment of Major Depressive Disorder: Systematic Review and Meta-Analysis.

IF 5.3 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica Pub Date : 2024-12-03 DOI:10.1111/acps.13778

Vikas Menon, Parthasarathy Ramamurthy, Sandesh Venu, Chittaranjan Andrade

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引用次数: 0

Abstract

Introduction: There is growing interest in the use of psychedelic-assisted therapy (PAT) for major depressive disorder (MDD), including treatment-resistant depression. We used randomized controlled trial (RCT) data to compare summary estimates of change in depression ratings with PAT versus comparator treatments in MDD. We also compared response and remission rates, and adverse effects.

Methods: We searched MEDLINE, EMBASE, Cochrane Central Register for Controlled Trials (CENTRAL), and SCOPUS from inception till April 2024. Our primary efficacy outcome was 1-week (or nearest) between-group change in depression ratings. Secondary efficacy outcomes were changes in depression ratings at days 2, 14, and 42 (or nearest) and study-defined response and remission rates at week 1 (or nearest). Safety outcomes were reported adverse effects. We pooled outcomes in random-effects meta-analyses using standardized mean difference (SMD; Hedges g) for continuous outcomes and risk ratio (RR) for categorical outcomes.

Results: We found 6 eligible RCTs (pooled N = 427), all on psilocybin. The pooled SMD for 1-week between-group change in depression ratings was -0.72 [95% CI, -0.95 to -0.49; I2 = 17%; 5 RCTs; n = 403], favouring PAT; results were similar at days 2, 14, and 42. The response [RR = 3.42; 95% CI, 2.35-4.97; I2 = 0%; 4 RCTs; n = 373] and remission [RR = 3.66; 95% CI, 2.26-5.92; I2 = 0%; 4 RCTs; n = 373] rates also favored PAT. The PAT group had a small but significantly increased risk of developing any adverse event [RR = 1.20; 95% CI, 1.01-1.42; I2 = 43%; 4 RCTs; n = 373] and a significantly higher risk of experiencing headache [RR = 1.78; 95% CI, 1.10-2.86; I2 = 52%; 4 RCTs; n = 373] and dizziness [RR = 6.52; 95% CI, 1.19-35.87; I2 = 0%; 3 RCTs; n = 269]. Low heterogeneity characterized most analyses and findings were similar in sensitivity analyses.

Conclusion: Antidepressant effects of psilocybin-assisted therapy are superior (with at least medium effect sizes) to comparator interventions for at least up to 6 weeks postintervention.

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裸盖菇素辅助治疗重度抑郁症的随机对照试验：系统回顾和荟萃分析。

导读：人们对使用迷幻剂辅助疗法（PAT）治疗重度抑郁症（MDD）越来越感兴趣，包括难治性抑郁症。我们使用随机对照试验（RCT）数据来比较PAT治疗与比较治疗对重度抑郁症抑郁评分变化的总体估计。我们还比较了缓解率和缓解率以及不良反应。方法：检索MEDLINE、EMBASE、Cochrane中央对照试验注册库（Central）和SCOPUS数据库，检索时间自成立至2024年4月。我们的主要疗效终点是1周（或最接近）抑郁评分组间变化。次要疗效结果是第2、14和42天（或最近）抑郁评分的变化，以及第1周（或最近）研究定义的缓解率和缓解率。安全性结果报告了不良反应。我们使用标准化平均差(SMD；对连续结果进行套期保值，对分类结果进行风险比（RR）套期保值。结果：我们找到6个符合条件的rct（共427个），均为裸盖菇素。1周抑郁评分组间总SMD变化为-0.72 [95% CI, -0.95至-0.49；i2 = 17%；5相关;n = 403]，支持PAT；第2、14和42天的结果相似。应答率[RR = 3.42；95% ci, 2.35-4.97；i2 = 0%；4相关的;n = 373]和缓解[RR = 3.66；95% ci, 2.26-5.92；i2 = 0%；4相关的;n = 373]的比率也有利于PAT。PAT组发生不良事件的风险虽小但显著增加[RR = 1.20；95% ci, 1.01-1.42；i2 = 43%；4相关的;n = 373]和出现头痛的风险显著增加[RR = 1.78；95% ci, 1.10-2.86；i2 = 52%；4相关的;n = 373]和头晕[RR = 6.52；95% ci, 1.19-35.87；i2 = 0%；3相关;n = 269]。大多数分析具有低异质性，敏感性分析的结果相似。结论：在干预后至少6周内，裸盖菇素辅助治疗的抗抑郁效果优于对照干预（至少具有中等效应量）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Psychiatrica Scandinavica 医学-精神病学

CiteScore

11.20

自引率

3.00%

发文量

135

审稿时长

6-12 weeks

期刊介绍： Acta Psychiatrica Scandinavica acts as an international forum for the dissemination of information advancing the science and practice of psychiatry. In particular we focus on communicating frontline research to clinical psychiatrists and psychiatric researchers. Acta Psychiatrica Scandinavica has traditionally been and remains a journal focusing predominantly on clinical psychiatry, but translational psychiatry is a topic of growing importance to our readers. Therefore, the journal welcomes submission of manuscripts based on both clinical- and more translational (e.g. preclinical and epidemiological) research. When preparing manuscripts based on translational studies for submission to Acta Psychiatrica Scandinavica, the authors should place emphasis on the clinical significance of the research question and the findings. Manuscripts based solely on preclinical research (e.g. animal models) are normally not considered for publication in the Journal.