阿米替林和其他治疗抑郁症的药物。
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郭亚娜，李文杰，李志强
阿米替林和其他治疗抑郁症的药物。
Cochrane Database Syst Rev. 2003;(2):CD004186。doi: 10.1002 / 14651858。CD004186。
- PubMed ID
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12804503 (PubMed视图］
- 摘要
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背景:多年来阿米替林一直被认为是抑郁症药物治疗的参考化合物之一。然而，新的三环药物、杂环化合物和选择性血清素再摄取抑制剂已经上市，并声称具有更有利的耐受性/疗效。目的:本系统综述的目的是研究阿米替林与其他三环/杂环抗抑郁药和选择性血清素再摄取抑制剂的耐受性和疗效。必威国际app检索策略:检索Cochrane协查抑郁、焦虑和神经症对照试验登记(2002-3)和Cochrane中央对照试验登记(Central)。主要期刊和会议摘要都是手工检索的。必威国际app有关未发表材料的信息联系了制药公司。选择标准:仅纳入随机对照试验。研究参与者的性别和年龄都有抑郁症的初步诊断。包括阿米替林与另一种三环/杂环抗抑郁药或一种选择性血清素再摄取抑制剂的比较试验。数据收集和分析:使用标准化表格提取数据。 The number of patients undergoing the randomisation procedure, the number of patients who completed the study and the number of improved patients were extracted. In addition, group mean scores at the end of the trial on Hamilton Depression Scale or any other depression scale were extracted. In the tolerability analysis, the number of patients failing to complete the study and the number of patients complaining of side-effects was extracted. MAIN RESULTS: The estimate of the overall odds ratio for responders showed that more subjects responded to amitriptyline in comparison with the control antidepressant group (odds ratio 1.12, 95% confidence interval 1.01, 1.23, number needed to treat 50). The estimate of the efficacy of amitriptyline and control agents on a continuous outcome revealed an effect size which also significantly favoured amitriptyline (Standardised Mean Difference 0.13, 95% confidence interval 0.04, 0.23). Whilst these differences are statistically significant, their clinical significance is less clear. When the efficacy analysis was stratified by drug class, no difference in outcome emerged between amitriptyline and either tricyclic or selective serotonin reuptake inhibitor comparators. The dropout rate in patients taking amitriptyline and control agents was similar; however, the estimate of the proportion of patients who experienced side-effects significantly favoured control agents in comparison with amitriptyline (odds ratio 0.63, 95% confidence interval 0.56, 0.71). When the tolerability analysis was stratified by drug class, the dropout rate in patients taking amitriptyline and the selective serotonin reuptake inhibitors significantly favoured the latter (odds ratio 0.84, 95% confidence interval 0.75,0.95, number needed to harm 40). When the responder analysis was stratified by study setting amitriptyline was more effective than control ADs in inpatients (odds ratio 1.22, 95% confidence interval 1.04, 1.42, number needed to treat 24), but not in outpatients (odds ratio 1.01, 95% confidence interval 0.88, 1.17, number needed to treat = 200). REVIEWER'S CONCLUSIONS: This present systematic review indicates that amitriptyline is at least as efficacious as other tricyclics or newer compounds. However, the burden of side-effects in patients receiving it was greater. In comparison with the selective serotonin reuptake inhibitors amitriptyline was less well tolerated, and although counterbalanced by a higher proportion of responders, the difference was not statistically significant.
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