背景:抗精神病药物越来越多地用于难以治疗的年轻人抑郁症。然而,这方面的证据基础尚不清楚。我们的目的是评估非典型抗精神病药物治疗青少年和年轻人单相和双相抑郁的有效性的证据。
方法:我们对10至25岁单相和双相抑郁患者的抗精神病药物随机对照试验研究(RCT)进行了全面的系统评价和荟萃分析。感兴趣的主要结果是抑郁症状从基线到试验终点的变化。
结果:没有发现评估抗精神病药物治疗单相抑郁症的研究。然而,我们确定了四项研究,喹硫平,鲁拉西酮和奥氮平/氟西汀组合,共有866名随机患者,评估双相抑郁的治疗方法。所有研究均使用儿童抑郁量表修订(CDRS-R)。我们的荟萃分析显示,抗精神病药和安慰剂治疗组之间的加权平均差(WMD)为-4.58(95%CI,-6.59至-2.57)。反应和缓解率也显着有利于抗精神病药物治疗。
结论:研究很少,一些研究没有涉及偏倚风险领域,并且缺乏非工业界赞助的研究.
结论:没有证据表明使用抗精神病药物治疗青年单相抑郁症,无法提出任何建议。有一些证据表明抗精神病药的疗效,特别是鲁拉西酮和奥氮平/氟西汀的组合,用于治疗患有双相抑郁症的年轻人。然而,这一证据是有限的,需要更多的研究来调查这些药物在年轻人中的使用情况.
Antipsychotic medications are increasingly used for difficult-to-treat depression in young people. However, the evidence-base for this is unclear. Our aim was to assess the evidence for the efficacy of atypical antipsychotics in treating unipolar and bipolar depression in adolescents and young adults.
We conducted a comprehensive systematic
review and meta-analysis of randomized-control-trial studies (RCTs) of antipsychotic medications for 10- to 25-year-olds with unipolar and bipolar depression. The primary outcome of interest was change in depressive symptoms from baseline to trial endpoint.
No studies were identified that evaluated the use of antipsychotics in the treatment of unipolar depression. However, we identified four studies, of quetiapine, lurasidone and olanzapine/fluoxetine combination, comprising a total of 866 randomized patients, that evaluated treatment of bipolar depression. All studies used the Children\'s Depression Rating Scale-Revised (CDRS-R). Our meta-analysis revealed the weighted mean difference (WMD) was -4.58 (95 % CI, -6.59 to -2.57) between antipsychotic and placebo-treated groups. Response and remission rates were also significantly in favor of antipsychotic treatment.
There were few studies, several did not address risk-of-bias domains and there was a lack of non-industry sponsored studies.
There is an absence of evidence for the use of antipsychotic medications in treatment of youth unipolar depression, and no recommendations can be made. There is some evidence for the efficacy of antipsychotics, specifically lurasidone and olanzapine/fluoxetine combination, in the treatment of young people with bipolar depression. However, this evidence is limited and more studies investigating the use of these medications in young people are needed.