药物干预治疗混合性重度抑郁症和双相抑郁症的疗效:系统综述。

IF 4.5 2区 医学 Q1 CLINICAL NEUROLOGY
Naomi Xiao, Liyang Yin, Serene Lee, Kayla M. Teopiz, Sabrina Wong, Gia Han Le, Sebastian Badulescu, Heidi Ka. Ying. Lo, Maj Vinberg, Bing Cao, Iria Grande, Joshua D. Rosenblat, Roger S. McIntyre
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引用次数: 0

摘要

背景:有必要提供最新的、临床可翻译的数据,因为它涉及到混合特征的重度抑郁发作(MDE)的治疗。方法:检索PubMed和OVID自建站至2024年7月22日。随机对照试验(RCTs)研究了药物治疗成人双相情感障碍(BD)或重度抑郁症(MDD)混合特征MDE的疗效。使用Cochrane随机研究偏倚风险工具(RoB2)评估偏倚风险。结果:本系统综述共纳入7项研究。所确定的研究均为6至8周的短期急性研究。鲁拉西酮、奥氮平、卡吡嗪、lumateperone、喹硫平和齐拉西酮治疗与具有混合特征的MDEs抑郁症状的显著减少相关。只有lumateperone在双相情感障碍亚型[双相情感障碍I型(BD-I),双相情感障碍II型(BD-II)]和重度抑郁症中进行了研究,其中混合特征的疗效是预先指定的主要结果。鲁拉西酮在MDD中只有一项研究,而齐拉西酮在BD-II和MDD的混合样本中有数据。混合特征中其他代理的数据是事后的。同时出现的轻躁症状普遍得到改善,上述治疗与安慰剂在轻躁症状严重程度加重或治疗后出现的情感转换方面无显著差异。结论:选择非典型抗精神病药物可有效缓解混合性抑郁患者的抑郁症状;虽然,很多数据是从事后分析中获得的。很少有证据表明锂或丙戊酸盐治疗混合性抑郁发作的疗效。抗抑郁药单药治疗在具有混合特征的抑郁发作中尚未得到充分评价。此外,迫切需要对混合表现进行一致的定义,以指导未来的介入研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

The Efficacy of Pharmacological Interventions in the Treatment of Major Depressive Disorder and Bipolar Depression With Mixed Features: A Systematic Review

The Efficacy of Pharmacological Interventions in the Treatment of Major Depressive Disorder and Bipolar Depression With Mixed Features: A Systematic Review

Background

There is a need to provide up-to-date, clinically translatable data as it relates to the treatment of a major depressive episode (MDE) with mixed features.

Methods

PubMed and OVID were searched from inception to July 22, 2024. Randomized controlled trials (RCTs) investigating the efficacy of pharmacological agents for adults with bipolar disorder (BD) or major depressive disorder (MDD) in an MDE with mixed features were included. Risk of bias was assessed using the Cochrane Risk of Bias Tool for Randomized Studies (RoB2).

Results

A total of seven studies were included in this systematic review. The studies identified were all short-term acute studies ranging from 6 to 8 weeks. Treatment with lurasidone, olanzapine, cariprazine, lumateperone, quetiapine, and ziprasidone was associated with statistically significant reduction of depressive symptoms in MDEs with mixed features. Only lumateperone is studied in both BD subtypes [bipolar I disorder (BD-I), bipolar II disorder (BD-II)] and MDD, wherein efficacy in mixed features was the prespecified primary outcome. Lurasidone has a single study in MDD, while ziprasidone has data in a mixed sample of BD-II and MDD. Data for the other agents in mixed features is post hoc. Co-occurring hypomanic symptoms generally improved, and there was no significant difference between the above treatments and placebo with respect to hypomanic symptom severity intensification or treatment-emergent affective switching.

Conclusion

Select atypical antipsychotics are effective in alleviating depressive symptoms in persons with mixed features; albeit, much of the data is obtained from post hoc analysis. Minimal evidence exists for the efficacy of lithium or valproate in the treatment of depressive episodes with mixed features. Antidepressant monotherapy has not been adequately evaluated in depressive episodes with mixed features. In addition, there is a pressing need for a consistent definition of mixed presentations to guide future interventional studies.

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来源期刊
Bipolar Disorders
Bipolar Disorders 医学-精神病学
CiteScore
8.20
自引率
7.40%
发文量
90
审稿时长
6-12 weeks
期刊介绍: Bipolar Disorders is an international journal that publishes all research of relevance for the basic mechanisms, clinical aspects, or treatment of bipolar disorders and related illnesses. It intends to provide a single international outlet for new research in this area and covers research in the following areas: biochemistry physiology neuropsychopharmacology neuroanatomy neuropathology genetics brain imaging epidemiology phenomenology clinical aspects and therapeutics of bipolar disorders Bipolar Disorders also contains papers that form the development of new therapeutic strategies for these disorders as well as papers on the topics of schizoaffective disorders, and depressive disorders as these can be cyclic disorders with areas of overlap with bipolar disorders. The journal will consider for publication submissions within the domain of: Perspectives, Research Articles, Correspondence, Clinical Corner, and Reflections. Within these there are a number of types of articles: invited editorials, debates, review articles, original articles, commentaries, letters to the editors, clinical conundrums, clinical curiosities, clinical care, and musings.
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