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首页> 外文期刊>The journal of clinical psychiatry >Mirtazapine versus other antidepressants in the acute-phase treatment of adults with major depression: systematic review and meta-analysis.
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Mirtazapine versus other antidepressants in the acute-phase treatment of adults with major depression: systematic review and meta-analysis.

机译：米氮平与其他抗抑郁药在成人重大抑郁症的急性期治疗中：系统评价和荟萃分析。

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OBJECTIVE: To conduct a comprehensive, systematic review and meta-analysis of the efficacy and tolerability of mirtazapine over other antidepressants in the acute-phase treatment of major depression. DATA SOURCES: Studies were initially identified through electronic searches of the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register up to June 2006. The following search terms were used: depress*, dysthymi*, adjustment disorder*, mood disorder*, affective disorder, affective symptoms, and mirtazapine. No language restriction was imposed. The reference lists of the included studies, previous relevant systematic reviews, and trial registers were also hand searched. Pharmaceutical companies and experts in the field were contacted for more studies. STUDY SELECTION: Twenty-five randomized controlled trials were included. DATA EXTRACTION: Two independent assessors examined the quality of the trials and extracted data on an intention-to-treat basis. DATA SYNTHESIS: The primary outcome measure was the relative risk (RR) of response (99% CIs) at the conclusion of acute-phase treatment. In relation to the early phase of treatment (at 2 weeks), there were no statistically significant differences between mirtazapine and the tricyclics in terms of the response (RR = 0.90, 99% CI = 0.69 to 1.18, p = .30 [8 trials contributed to this outcome]) or remission (RR = 0.87, 99% CI = 0.52 to 1.47, p = .50 [8 trials]) outcomes, but mirtazapine was superior to the selective serotonin reuptake inhibitors (SSRIs) in terms of both the response (RR = 1.36, 99% CI = 1.13 to 1.64, p < .0001 [12 trials]) and remission (RR = 1.68, 99% CI = 1.20 to 2.36, p < .0001 [12 trials]). In the subgroup analyses, mirtazapine significantly produced more response than paroxetine (RR = 2.02, 99% CI = 1.09 to 3.75, p = .003 [3 trials]) and venlafaxine (RR = 1.77, 99% CI = 1.08 to 2.89, p = .003 [2 trials]). At the end of acute-phase treatment (6-12 weeks, all trials), no significant differences were observed in the efficacy outcomes. No significant differences were observed between mirtazapine and the other antidepressants in terms of either the total number of dropouts due to any reason (21 trials) or the total number of dropouts due to the development of side effect (23 trials) during the trials. CONCLUSIONS: Although mirtazapine is likely to have a faster onset of action than SSRIs, no significant differences were observed at the end of 6 to 12 weeks' treatment. Clinicians should focus on other practically relevant considerations to tailor treatment to best fit the needs of individual patients.
机译：目的：对米氮平对其他抗抑郁药在急性抑郁症急性期的疗效和耐受性进行全面，系统的评价和荟萃分析。数据来源：研究最初是通过电子搜索Cochrane协作抑郁症，焦虑症和神经症对照试验注册进行的，直至2006年6月。使用了以下检索词：抑郁*，运动障碍*，适应障碍*，情绪障碍*，情感障碍，情感症状和米氮平。没有语言限制。还手动搜索了纳入研究的参考文献清单，先前的相关系统评价和试验登记册。联系了制药公司和该领域的专家以进行更多研究。研究选择：包括25个随机对照试验。数据提取：两名独立评估师检查了试验的质量，并从意向治疗的基础上提取了数据。数据综合：主要结局指标是急性期治疗结束时反应的相对危险度（RR）（99％CI）。与治疗的早期阶段（2周）相比，米氮平和三环类药物在反应方面无统计学差异（RR = 0.90，99％CI = 0.69至1.18，p = .30 [8个试验）或缓解（RR = 0.87，99％CI = 0.52至1.47，p = .50 [8个试验]）的结果，但米氮平在这两个方面均优于选择性5-羟色胺再摄取抑制剂（SSRI）。缓解（RR = 1.36，99％CI = 1.13至1.64，p <.0001 [12个试验]）和缓解（RR = 1.68，99％CI = 1.20至2.36，p <.0001 [12个试验]）。在亚组分析中，米氮平比帕罗西汀（RR = 2.02，99％CI = 1.09至3.75，p = 0.003 [3个试验]）和文拉法辛（RR = 1.77，99％CI = 1.08至2.89，p = 0.003 [2次试验]）。在急性期治疗结束时（6-12周，所有试验），疗效结果均未见明显差异。在试验期间，米氮平与其他抗抑郁药之间因任何原因导致的辍学总数（21项试验）或因发生副作用而导致的辍学总数（23项试验）均未观察到显着差异。结论：尽管米氮平可能比SSRIs起效更快，但在治疗6至12周后未观察到显着差异。临床医生应着重于其他与实践相关的考虑因素，以量身定制最适合患者需求的治疗方案。

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