Antidepressants and quality of life in patients with major depressive disorder – Systematic review and meta-analysis of double-blind, placebo-controlled RCTs

IF 5.3 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica Pub Date : 2023-03-11 DOI:10.1111/acps.13541

Teresa Wiesinger, Stefanie Kremer, Tom Bschor, Christopher Baethge

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引用次数: 4

Abstract

Background

Quality of Life (QoL) is an important outcome in mental disorders. We investigated whether antidepressant pharmacotherapy improved QoL vs. placebo among patients with MDD.

Methods

Systematic literature search in CENTRAL, Medline, PubMed Central, and PsycINFO of double-blind, placebo-controlled RCTs. Screening, inclusion, extraction, and risk of bias assessment were conducted independently by two reviewers. We calculated summary standardized mean differences (SMD) with 95%-CIs. We followed Cochrane Collaboration's Handbook of Systematic Reviews and Meta-Analyses and PRISMA guidelines (protocol registration at OSF).

Results

We selected 46 RCTs out of 1807 titles and abstracts screened, including 16.171 patients, 9131 on antidepressants and 7040 on placebo, a mean age of 50.9 years, with 64.8% women. Antidepressant drug treatment resulted in a SMD in QoL of 0.22 ([95%-CI: 0.18; 0.26] I² 39%) vs. placebo. SMDs differed by indication: 0.38 ([0.29; 0.46] I² 0%) in maintenance studies, 0.21 ([0.17; 0.25] I² 11%) in acute treatment studies, and 0.11 ([−0.05; 0.26], I² 51%) in studies focussing on patients with a physical condition and major depression. There was no indication of subtstantial small study effects, but 36 RCTs had a high or uncertain risk of bias, particularly maintenance trials. QoL and antidepressive effect sizes were associated (Spearman's rho 0.73, p < 0.001).

Conclusions

Antidepressants' effects on QoL are small in primary MDD, and doubtful in secondary major depression and maintenance trials. The strong correlation of QoL and antidepressive effects indicates that the current practice of measuring QoL may not provide sufficient additional insights into the well-being of patients.

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抗抑郁药和重度抑郁症患者的生活质量——双盲安慰剂对照随机对照试验的系统回顾和荟萃分析

生活质量(QoL)是精神障碍的一个重要指标。我们调查了抗抑郁药物治疗与安慰剂相比是否能改善重度抑郁症患者的生活质量。方法在CENTRAL、Medline、PubMed CENTRAL和PsycINFO中检索双盲、安慰剂对照的文献。筛选、纳入、提取和偏倚风险评估由两位审稿人独立进行。我们计算了95%- ci的总标准化平均差异(SMD)。我们遵循Cochrane Collaboration的《系统评价与荟萃分析手册》和PRISMA指南(在OSF注册的方案)。结果我们从筛选的1807篇标题和摘要中选择了46篇rct，包括16.171例患者，其中抗抑郁药9131例，安慰剂7040例，平均年龄50.9岁，其中64.8%为女性。抗抑郁药物治疗导致SMD的生活质量为0.22 (95%-CI: 0.18;0.26] I2 (39%) vs.安慰剂。不同适应症的smd差异:0.38 ([0.29;[0.46] I2 %)， 0.21 ([0.17;在急性治疗研究中，0.25]I2 11%)， 0.11([−0.05;0.26]， I2 51%)，主要针对身体状况和重度抑郁症患者的研究。没有迹象表明有实质性的小研究效应，但36项随机对照试验存在较高或不确定的偏倚风险，特别是维持试验。生活质量和抗抑郁效应大小相关(Spearman's rho 0.73, p < 0.001)。结论抗抑郁药物对原发性重度抑郁症患者生活质量的影响较小，对继发性重度抑郁症患者生活质量的影响值得怀疑。生活质量与抗抑郁作用的强相关性表明，目前测量生活质量的做法可能无法为患者的健康状况提供足够的额外见解。

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.