背景:选择性5-羟色胺再摄取抑制剂(SSRIs)被认为是治疗焦虑样疾病如恐慌症的一线药物,广泛性焦虑障碍,和创伤后应激障碍。恐惧学习在这些疾病的发展和治疗中起着重要作用。然而,SSRIs对恐惧学习的影响尚不为人所知。
目的:我们旨在系统评价6种临床有效的SSRIs对采集的影响,表达式,以及暗示和上下文条件恐惧的灭绝。
方法:我们搜索了Medline和Embase数据库,产生了128篇符合纳入标准的文章,并报道了9个人类和275个动物实验。
结果:Meta分析显示,SSRIs显著降低了情境恐惧表达,促进了灭绝学习提示。贝叶斯正则化的元回归进一步表明,与急性治疗相比,慢性治疗对提示的恐惧表达具有更强的抗焦虑作用。SSRI的类型,物种,疾病诱导模型,和使用的焦虑测试类型似乎不能减轻SSRIs的影响。研究的数量相对较少,异质性水平很高,和出版偏倚可能发生,这可能导致高估了整体效应大小。
结论:这篇综述表明,SSRIs的功效可能与它们对情境恐惧表达和消失的影响有关。而不是恐惧收购。然而,SSRIs的这些影响可能是由于对恐惧相关情绪的更普遍的抑制。因此,关于SSRIs对无条件恐惧反应的影响的其他荟萃分析可能会进一步深入了解SSRIs的作用.
BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs) are considered first-line medication for anxiety-like disorders such as panic disorder, generalized anxiety disorder, and post-traumatic stress disorder. Fear learning plays an important role in the development and treatment of these disorders. Yet, the effect of SSRIs on fear learning are not well known.
OBJECTIVE: We aimed to systematically
review the effect of six clinically effective SSRIs on acquisition, expression, and extinction of cued and contextual conditioned fear.
METHODS: We searched the Medline and Embase databases, which yielded 128 articles that met the inclusion criteria and reported on 9 human and 275 animal experiments.
RESULTS: Meta-analysis showed that SSRIs significantly reduced contextual fear expression and facilitated extinction learning to cue. Bayesian-regularized meta-regression further suggested that chronic treatment exerts a stronger anxiolytic effect on cued fear expression than acute treatment. Type of SSRI, species, disease-induction model, and type of anxiety test used did not seem to moderate the effect of SSRIs. The number of studies was relatively small, the level of heterogeneity was high, and publication bias has likely occurred which may have resulted in an overestimation of the overall effect sizes.
CONCLUSIONS: This
review suggests that the efficacy of SSRIs may be related to their effects on contextual fear expression and extinction to cue, rather than fear acquisition. However, these effects of SSRIs may be due to a more general inhibition of fear-related emotions. Therefore, additional meta-analyses on the effects of SSRIs on unconditioned fear responses may provide further insight into the actions of SSRIs.