A carregar...
Publicação
Psychostimulant augmentation of antidepressant therapy in depression : a systematic review and meta-analysis
| Nome: | Descrição: | Tamanho: | Formato: | |
|---|---|---|---|---|
| 1.14 MB | Adobe PDF |
Autores
Orientador(es)
Resumo(s)
Introdução: A depressão é um problema de saúde global, face à sua prevalência, morbilidade e distribuição internacional. Atualmente, o tratamento de primeira linha baseia-se em antidepressivos em monoterapia, com resultados modestos. Em contrapartida, os psicostimulantes constituem uma classe heterogénea cuja farmacodinâmica subjacente tem o potencial de poder complementar a ação dos antidepressivos e atuar nas bases fisiopatológicas da depressão, aportando, assim, benefícios clínicos.
Objetivos: Avaliar a eficácia da utilização de psicostimulantes adjuvantes a antidepressivos em adultos deprimidos.
Métodos de pesquisa: A 11/02/2023, foram realizadas buscas no PubMed, no Web of Science Core Collection e no ClinicalTrials.gov.
Critérios de seleção: Foram incluídos ECAs que avaliassem a eficácia da utilização de psicostimulantes em adjuvância a antidepressivos, em comparação com placebo adjuvante. Considerou-se uma população de adultos de ambos os sexos com um diagnóstico de PDM (DSM ou ICD).
Recolha e análise de dados: O autor extraiu os dados e avaliou o risco de viés. O outcome contínuo “Mudança na gravidade da depressão do início ao final do estudo” foi analisado com SMD e um IC de 95%, ao passo que o outcome dicotómico “Remissão no final do estudo” foi analisado com OR e um IC de 95%. As meta-análises foram realizadas com recurso a modelos de efeitos aleatórios.
Resultados: Foram incluídos treze ECAs (2478 participantes). As meta-análises revelaram que a adjuvância com psicostimulantes reduziu significativamente a gravidade dos sintomas depressivos [N=1827; SMD=-0.18; 95% CI (-0.36, -0.01); p=0.04, I2=65%], mas não demonstraram um aumento significativo nas taxas de remissão [N=1709; OR=1.30; 95% CI (0.97, 1.75); p=0.08, I2=32%].
Conclusões: A evidência sugere que a utilização de psicostimulantes melhora a sintomatologia depressiva. Não obstante, os dados obtidos não sugerem um benefício no que toca à remissão. Houve limitações significativas, pelo que serão necessários maiores ensaios de qualidade que avaliem uma maior variedade de psicostimulantes.
Background: Depression is a global health issue, owing to its prevalence, burden, and worldwide presence. Currently, first-line treatment uses antidepressants without augmentation, with modest results. Psychostimulants, on the other hand, are a heterogeneous class of drugs with underlying pharmacodynamic mechanisms that could potentially compliment standard antidepressant therapy and act on the pathophysiological bases of depression, and so achieve important clinical benefits. Objectives: To evaluate the effectiveness of psychostimulant augmentation of antidepressants in the treatment of depression in adults. Search methods: PubMed, Web of Science Core Collection, and ClinicalTrials.gov were searched on 11/02/2023. Selection criteria: RCTs which assessed the effectiveness of psychostimulant augmentation of antidepressants by comparing it with placebo augmentation were included. The population considered was of adult patients of either sex with a diagnosis of Major Depressive Disorder (DSM or ICD). Data collection and analysis: The review author extracted data and assessed risk of bias. The continuous outcome “Change in depression severity from baseline to end-of-study” was analyzed with standardized mean difference and 95% confidence interval, while the dichotomous outcome of “Remission at end-of-study” was analyzed with odds ratio and 95% confidence interval. Meta-analyses were performed using random-effects models. Main results: Thirteen RCTs (2478 participants) were included. The meta-analyses showed that psychostimulant augmentation significantly decreased depressive symptom severity in comparison with placebo augmentation [N=1827; SMD=-0.18; 95% CI (-0.36, -0.01); p=0.04, I2=65%], but failed to reveal a significant increase in remission rates [N=1709; OR=1.30; 95% CI (0.97, 1.75); p=0.08, I2=32%]. Author’s conclusions: Current evidence suggests that psychostimulant augmentation of antidepressants is an effective strategy for improving depressive symptoms. Nevertheless, the data does not suggest a benefit regarding remission. Significant limitations were encountered, thus larger high-quality trials assessing a wider variety of psychostimulants are needed to further explore these findings.
Background: Depression is a global health issue, owing to its prevalence, burden, and worldwide presence. Currently, first-line treatment uses antidepressants without augmentation, with modest results. Psychostimulants, on the other hand, are a heterogeneous class of drugs with underlying pharmacodynamic mechanisms that could potentially compliment standard antidepressant therapy and act on the pathophysiological bases of depression, and so achieve important clinical benefits. Objectives: To evaluate the effectiveness of psychostimulant augmentation of antidepressants in the treatment of depression in adults. Search methods: PubMed, Web of Science Core Collection, and ClinicalTrials.gov were searched on 11/02/2023. Selection criteria: RCTs which assessed the effectiveness of psychostimulant augmentation of antidepressants by comparing it with placebo augmentation were included. The population considered was of adult patients of either sex with a diagnosis of Major Depressive Disorder (DSM or ICD). Data collection and analysis: The review author extracted data and assessed risk of bias. The continuous outcome “Change in depression severity from baseline to end-of-study” was analyzed with standardized mean difference and 95% confidence interval, while the dichotomous outcome of “Remission at end-of-study” was analyzed with odds ratio and 95% confidence interval. Meta-analyses were performed using random-effects models. Main results: Thirteen RCTs (2478 participants) were included. The meta-analyses showed that psychostimulant augmentation significantly decreased depressive symptom severity in comparison with placebo augmentation [N=1827; SMD=-0.18; 95% CI (-0.36, -0.01); p=0.04, I2=65%], but failed to reveal a significant increase in remission rates [N=1709; OR=1.30; 95% CI (0.97, 1.75); p=0.08, I2=32%]. Author’s conclusions: Current evidence suggests that psychostimulant augmentation of antidepressants is an effective strategy for improving depressive symptoms. Nevertheless, the data does not suggest a benefit regarding remission. Significant limitations were encountered, thus larger high-quality trials assessing a wider variety of psychostimulants are needed to further explore these findings.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Augmentation Depression Psychostimulant Remission Symptom severity Psiquiatria