Augmentation strategies for treatment resistant major depression: A systematic review and network meta-analysis

奎硫平 奥氮平 阿立哌唑 齐拉西酮 心理学 中止 利培酮 氟西汀 安慰剂 医学 内科学 精神科 药理学 精神分裂症(面向对象编程) 受体 替代医学 病理 血清素
作者
Nicolás A. Núñez,Boney Joseph,Mehak Pahwa,Rakesh Kumar,Manuel Gardea‐Resendez,Larry J. Prokop,Marin Veldić,Ashok Seshadri,Joanna M. Biernacka,Mark A. Frye,Zhen Wang,Balwinder Singh
出处
期刊:Journal of Affective Disorders [Elsevier BV]
卷期号:302: 385-400 被引量:72
标识
DOI:10.1016/j.jad.2021.12.134
摘要

To compare the efficacy and discontinuation of augmentation agents in adult patients with treatment-resistant depression (TRD). We conducted a systematic review and network meta-analyses (NMA) to combine direct and indirect comparisons of augmentation agents.We included randomized controlled trials comparing one active drug with another or with placebo following a treatment course up to 24 weeks. Nineteen agents were included: stimulants, atypical antipsychotics, thyroid hormones, antidepressants, and mood stabilizers. Data for response/remission and all-cause discontinuation rates were analyzed. We estimated effect-size by relative risk using pairwise and NMA with random-effects model.A total of 65 studies (N = 12,415) with 19 augmentation agents were included in the NMA. Our findings from the NMA for response rates, compared to placebo, were significant for: liothyronine, nortriptyline, aripiprazole, brexpiprazole, quetiapine, lithium, modafinil, olanzapine (fluoxetine), cariprazine, and lisdexamfetamine. For remission rates, compared to placebo, were significant for: thyroid hormone(T4), aripiprazole, brexpiprazole, risperidone, quetiapine, and olanzapine (fluoxetine). Compared to placebo, ziprasidone, mirtazapine, and cariprazine had statistically significant higher discontinuation rates. Overall, 24% studies were rated as having low risk of bias (RoB), 63% had moderate RoB and 13% had high RoB.Heterogeneity in TRD definitions, variable trial duration and methodological clinical design of older studies and small number of trials per comparisons.This NMA suggests a superiority of the regulatory approved adjunctive atypical antipsychotics, thyroid hormones, dopamine compounds (modafinil and lisdexamfetamine) and lithium. Acceptability was lower with ziprasidone, mirtazapine, and cariprazine. Further research and head-to-head studies should be considered to strengthen the best available options for TRD.
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