選擇性血清素再回收抑制劑與三環抗憂鬱藥用於
憂鬱症之臨床療效與副作用之探討：統合分析

研究背景：用來治療憂鬱症的藥品當中，三環抗憂鬱藥 (TCAs)一直是一個不錯的選擇。然而，新上市的選擇性血清素再回收抑制劑 (SSRIs) 通常被認為比起三環抗憂鬱藥，有更好的療效以及比較少的不良反應。研究目的：本研究使用統合分析meta-analysis的方法，比較TCAs與SSRIs之相對療效以及耐藥性。研究方法：我們經由網際網路的資料庫，搜尋Cochrane Collaboration所提供的一些有關於憂鬱症、焦慮症、精神疾病方面的文獻報導，也從MEDLINE, EMBASE, SDOS, PubMed, JAMA和American Chemical Society及New England Journal of Medicine等國外著名的期刊，搜尋與本研究相關之文獻。這些文獻所發表的時間是從西元1984-2006年。大部份所蒐集的文獻資料均來自於隨機試驗。其中不論性別及年齡大小，只要參與的受試者經由診斷為憂鬱症患者的療效試驗，皆納入。數據則是來自於所蒐集的每一篇文獻當中，所包含的療效反應，或者是因為無效及副作用產生的中斷治療之比例。使用Review Manager 4.2.6的版本進行一聨串關於療效及副作用的統合分析。療效分析的結果包含異質性的評估。結果與討論：最後一共有38篇的文獻數據被納入統合分析中，進行關於TCAs及SSRIs之療效與副作用的比較。在分析所有重鬱症的療效反應之中，於SSRIs這一組加總了16,186個樣本數；於TCAs這一組加總了12,125個樣本數。儘管TCAs在治療重度憂鬱症的患者當中顯示出有較好的療效 (勝算比為0.89, 95%的信賴區間為[0.82, 0.97], p = 0.009)，但是在治療情緒低落患者的療效比較上，則是以SSRIs之療效顯示出具有顯著之差異 (勝算比為1.39，95% 的信賴區間為[0.88, 2.22], p = 0.16)。觀察全面中斷治療的停藥比較上，SSRIs比TCAs有較少的停藥比率 (勝算比為0.83, 95% 的信賴區間為[0.77, 0.89], p < 0.00001)；因為無效而停藥的比較上，SSRIs則顯現出比TCAs還要高的停藥比例 (勝算比為1.13, 95% 的信賴區間為[1.05, 1.21], p = 0.0008)；在因為不良反應產生而停藥的比較上，SSRIs則是顯現出比TCAs低的停藥比例 (勝算比為0.65, 95%的信賴區間等於[0.61, 0.70], p<0.00001)。結論：在治療重度憂鬱症的療效上，TCAs似乎較具有統計上明顯之差異。然而，在治療期間的停藥比率上，顯示出SSRIs似乎比TCAs低。

關鍵字

統合分析；三環抗憂鬱藥；選擇性血清素再回收抑制劑

並列摘要

Background: Tricyclic antidepressants (TCAs) have been considered as one of the pharmacological treatments of depression. However, the newly marketed selective serotonin reuptake inhibitors (SSRIs) are generally though to have better efficacies and fewer side effects clinically than TCAs. Objectives: The purpose of this study was to compare the relative efficacies and tolerability of SSRIs and TCAs using meta-analysis. Methods: We searched the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Registers, MEDLINE, EMBASE, SDOS, PubMed, and JAMA. The literature search also included American Chemical Society, and New England Journal of Medicine which were from the database. Most of randomized controlled trials were included in this study. Study participants could include both genders and any age range with a primary diagnosis of depression. Data collected from each study included proportion of responders or drop-outs due to side effect and ineffectiveness. A series of meta-analyses of regarding therapy efficacies and side effects were performed using Review Manager v.4.2.6. Heterogeneity of treatment effect was considered. Results and Discussion: Thirty-eight trials were finally selected and contributed data to the meta-analysis of the relative efficacy of SSRIs and TCAs. Analysis of efficacy of drug therapy in depression resulted from 16,186 patients treated with SSRIs; 12,125 patients treated with TCAs. TCAs could be a better choice for patients with severe or major depression (odds ratio 0.89, 95% CI= [0.82, 0.97], p = 0.009). Drug efficacy in dysthymia control significantly favored in SSRIs (odds ratio 1.39, 95% CI= [0.88, 2.22], p = 0.16), although less drop-out rate for SSRIs therapy group was observed than that of TCAs (odds ratio 0.83, 95% CI= [0.77, 0.89], p<0.00001). The total drop-outs due to inefficacy for SSRIs was higher than that of TCAs (odds ratio 1.13, 95% CI= [1.05, 1.21], p = 0.0008). In the aspect of side effects, drop-out rate due to side effects for SSRIs was lower than that of TCAs (odds ratio 0.65, 95% CI= [0.61, 0.70], p<0.00001). Conclusions: Even though there are significant differences in efficacies of drug therapy for patients with major-depression between SSRIs and TCAs that is favor TCAs. SSRIs do appear to show an advantage over TCAs in terms of total drop-outs.

並列關鍵字

Meta-analysis ； TCAs ； SSRIs

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