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首页> 外文期刊>The journal of clinical psychiatry >Antidepressants for the acute treatment of bipolar depression: a systematic review and meta-analysis.
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Antidepressants for the acute treatment of bipolar depression: a systematic review and meta-analysis.

机译：抗抑郁药用于双相抑郁症的急性治疗：系统评价和荟萃分析。

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OBJECTIVE: The role of antidepressants in the acute treatment of bipolar depression remains a contentious issue. A previous meta-analysis of randomized controlled trials (RCTs) concluded that antidepressants were effective and safe for bipolar depression. Several trials published since then suggest that antidepressants may not be as beneficial as previously concluded. The current systematic review and meta-analyses reexamine the efficacy and safety of antidepressant use for the acute treatment of bipolar depression. DATA SOURCES: EMBASE, MEDLINE, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials databases were searched for double-blind RCTs published from 2003 to 2009 using the following diagnostic medical subject heading (MESH) terms: bipolar disorder, bipolar depression, bipolar I disorder, bipolar II disorder, bipolar III disorder, bipolar mania, cyclothymia, manic depressive psychosis, mixed mania and depression, and rapid cycling and bipolar disorder. Databases of trial registries were also searched for unpublished RCTs. These searches were supplemented by hand searches of relevant articles and review articles. STUDY SELECTION: Trials that compared acute (< 16 wk) antidepressant treatment with either an active drug or a placebo comparator in adult bipolar patients, depressive phase were eligible for inclusion. Main outcome measures were clinical response, remission, and affective switch. DATA SYNTHESIS: Six RCTs (N = 1,034) were identified since publication in 2004 of the first meta-analysis that assessed antidepressant use in the acute treatment of bipolar depression. These studies were combined with earlier studies for a total of 15 studies containing 2,373 patients. Antidepressants were not statistically superior to placebo or other current standard treatment for bipolar depression. Antidepressants were not associated with an increased risk of switch. Studies that employed more sensitive criteria to define switch did report elevated switch rates for antidepressants. CONCLUSIONS: Although antidepressants were found to be safe for the acute treatment of bipolar depression, their lack of efficacy may limit their clinical utility. Further high-quality studies are required to address the existing limitations in the literature.
机译：目的：抗抑郁药在急性躁郁症的急性治疗中的作用仍然是一个有争议的问题。先前对随机对照试验（RCT）进行的荟萃分析得出结论，抗抑郁药对双相抑郁症有效且安全。此后发表的几项试验表明，抗抑郁药可能没有以前得出的结论那么有益。当前的系统评价和荟萃分析重新检查了抗抑郁药在急性双相抑郁症治疗中的有效性和安全性。资料来源：搜寻EMBASE，MEDLINE，CINAHL，PsycINFO和Cochrane对照试验中央注册数据库，使用以下诊断医学主题词（MESH）术语搜索2003年至2009年发布的双盲RCT：双相情感障碍，双相抑郁， I型躁郁症，II型躁郁症，III型躁郁症，躁郁症，狂躁症，躁狂抑郁症，躁狂和抑郁混合症，快速骑自行车和躁郁症。还搜索了试验注册数据库，以查找未发布的RCT。这些搜索由相关文章和评论文章的手工搜索得到补充。研究选择：在成年双相情感障碍患者中，将抑郁（急性期<16 wk）抗抑郁药与活性药物或安慰剂比较剂进行比较的试验符合入选条件。主要结局指标为临床反应，缓解和情感转换。数据综合：自2004年首次进行荟萃分析以来，共鉴定了6个RCT（N = 1,034），该荟萃分析评估了抗抑郁药在双相抑郁症的急性治疗中的应用。这些研究与早期研究相结合，总共进行了15项研究，包含2,373名患者。对于双相抑郁症，抗抑郁药在统计学上并不优于安慰剂或其他当前标准治疗方法。抗抑郁药与换药风险增加无关。使用更敏感的标准定义转换的研究确实报告了抗抑郁药的转换率升高。结论：尽管发现抗抑郁药可用于急性治疗双相抑郁症，但其缺乏疗效可能会限制其临床应用。为了解决文献中存在的局限性，需要进行进一步的高质量研究。

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