评价锂盐治疗急性双相抑郁的疗效。
我们进行了系统的文献综述:1)交叉或平行组设计研究,比较双极和单极抑郁症患者的锂反应,和2)双相抑郁患者的平行组研究,比较锂与安慰剂或其他精神药物。使用反应率作为主要结果进行Meta分析,以评估锂的疗效。
文献检索产生947条记录。最终,包括17项研究,共1545名患者,包括676人接受锂。总体汇总效果表明,锂与抗抑郁药或安慰剂之间没有统计学上的显着差异,然而,锂在数值上比抗抑郁药差(RR=0.61;95CI,0.37-1.02;p=0.06),但比安慰剂好(RR=1.18;95CI,0.99-1.41;p=0.07).在所有试验的主要分析中,锂对双极抑郁与单极抑郁的特异性均未得到支持。尽管分析仅限于双盲,单一疗法,交叉研究显示,有统计学意义的结果支持锂对双相抑郁患者的疗效。
限制包括研究选择规则,使用反应率而不是缓解率或连续评分结果,以及每个荟萃分析中包含的少量研究。
这些荟萃分析不支持锂作为急性双相抑郁的一线治疗。然而,双极与单极敏感性分析和适度,尽管与安慰剂相比无显著优势,但锂盐可能仍是一种可行的治疗选择.需要更大规模和更严格设计的研究来确定锂相对于安慰剂和其他精神药物的全部功效。
To evaluate lithium in the treatment of acute bipolar depression.
We conducted a systematic literature
review for: 1) cross-over or parallel-group design studies comparing lithium response in bipolar versus unipolar depressed patients, and 2) parallel group studies of bipolar depressed patients comparing lithium versus placebo or other psychotropics. Meta-analyses using response rate as the primary outcome were conducted to evaluate lithium\'s efficacy.
The literature search yielded 947 records. Ultimately, 17 studies were included, totaling 1545 patients, including 676 who received lithium. The overall summary effects reveal that there were no statistically significant differences between lithium versus antidepressants or placebo, however, lithium performed numerically worse than antidepressants (RR = 0.61; 95%CI, 0.37-1.02; p = 0.06) but better than placebo (RR = 1.18; 95%CI, 0.99-1.41; p = 0.07). The specificity of lithium for bipolar versus unipolar depression was not supported in the primary analysis of all trials, though an analysis limited to double-blinded, monotherapy, cross-over studies revealed a statistically significant result supporting lithium\'s efficacy for those with bipolar depression.
Limitations include study selection rules, the use of response rates rather than remission rates or continuous score outcomes, and the small number of studies included in each meta-analysis.
These meta-analyses do not support lithium as a first-line treatment for acute bipolar depression. However, the bipolar vs. unipolar sensitivity analysis and the modest, though non-significant advantage over placebo suggest lithium may still be a viable treatment option. Larger and more rigorously-designed studies are needed to determine lithium\'s full range of efficacy relative to placebo and other psychotropics.