米氮平与氟西汀治疗成人抑郁症疗效及安全性的Meta分析_《中国循证医学杂志》

作者：

1. 安徽医科大学附属安徽省立医院(合肥 230001);2. 四川大学华西医院中国循证医学中心(成都 610041);3. 安徽医科大学临床药理研究所(合肥 230032);

关键词：

米氮平氟西汀抑郁症 Meta 分析

DOI：

10.7507/1672-2531.20100385

视频：

导出 下载 收藏 扫码 引用

摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　系统评价米氮平与氟西汀比较治疗成人抑郁症的疗效及不良反应。
方法　计算机检索 Cochrane Library(2009 年第 2 期)、MEDLINE(1980 ~ 2008 年 12 月)、EMbase(1980 ~ 2008 年 12 月)、CBM(1980 ~ 2008 年 12 月)、VIP(1980 ~ 2008 年 12 月)、CNKI(1980 ~ 2008 年 12 月)、万方数据库(1980 ~ 2008 年 12 月),纳入米氮平与氟西汀比较治疗成年抑郁症的随机对照试验(RCT),对纳入 RCT 进行质量评价,采用 RevMan 5.0 软件进行 Meta 分析。
结果　共纳入 5 个 RCT,包括 695 例抑郁症患者。Meta 分析结果显示:1 治疗后 1 周和 2 周米氮平组的有效性均显著高于氟西汀组[1 周:RR=2.00,95%CI(1.30,3.10),P=0.002;2 周: RR=1.49,95%CI(1.08,2.06), P=0.02];但治疗 6 周后米氮平组与氟西汀组的有效性差异无统计学意义[RR=1.21,95%CI(0.89,1.63),P=0.23]; 第 6 周治愈率米氮平组略高于氟西汀组[RR=1.40,95%CI(1.09,1.80),P=0.009]。2 不良反应:米氮平组的嗜睡、体重增加发生率高于氟西汀组[RR=1.78,95%CI(1.18,2.70),P=0.006; RR=5.91,95%CI(2.21,15.83),P=0.000 4], 恶心、失眠发生率低于氟西汀组[RR=0.47,95%CI(0.31,0.71),P=0.000 3;RR=0.39,95%CI(0.17,0.89),P=0.03], 其余常见不良反应差异无统计学意义(P gt;0.05)。
结论　米氮平抗抑郁疗效优于氟西汀且起效较快,在常见不良反应中,米氮平更易引起嗜睡及体重增加,氟西汀更易引起恶心及失眠,其余不良反应两组差异无统计学意义。

引用本文： 周冉,徐维平,王莉,徐婷娟,胡世莲,严光,魏伟,李幼平. 米氮平与氟西汀治疗成人抑郁症疗效及安全性的Meta分析. 中国循证医学杂志, 2010, 10(2): 196-202. doi: 10.7507/1672-2531.20100385 复制

1.	Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020:Global Burden of Disease Study.Lancet, 1997, 349(9064): 1498-1504.
2.	Sonawalla SB, Fava M. Severe depression:is there a best approach? CNS Drugs, 2001, 15(10): 765-776.
3.	Thomas CM, Morris S. Cost of depression among adults in England in 2000. Br J Psychiatry, 2003, 183: 514-519.
4.	Wang PS, Simon G, Kesler RC, et al. The economic burden of depression and the cost-effectiveness of treatment. Int J Methods Psychiatry Res, 2003, 12(1): 22-33.
5.	de Boer T. The effects of mirtazapine on central noradrenergic and serotonergic neurotransmission. Int Clin Psychopharmacol, 1995, 10(Suppl 4): 19-23.
6.	Benkert O, Szegedi A, Kohnen R, et al. Mirtazapine compared with paroxetine in major depression. J Clin Psychiatry, 2000, 61(9): 656-663.
7.	Kasper S. Clinical efficacy of mirtazapine:a review of meta-analyses of pooled data. Int Clin Psychopharmacol, 1995, 10(Suppl 4): 25-35.
8.	Watanabe N, Omori IM, Nakagawa A, et al. Mirtazapine versus other antidepressants in the acute-phase treatment of adults with major depression: systematic review and meta-analysis. J Clin Psychiatry, 2008, 69(9): 1404-1415.
9.	Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry, 1960, 23: 56-62.
10.	Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials:is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
11.	Schulz KF, Chalmers I, Hayes RJ, et al. Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA, 1995, 273(5): 408-412.
12.	Amini H, Aghayan S, Jalili SA, et al. Comparison of mirtazapine and fluoxetine in the treatment of major depressive disorder: a doubleblind, randomized trial. J Clin Pharm Ther, 2005, 30(2): 133-138.
13.	Versiani M, Moreno R, Ramakers-van Moorsel CJ, et al. Comparative Efficacy Antidepressants Study Group.Comparison of the effects of mirtazapine and fluoxetine in severely depressed patients. CNS Drugs, 2005, 19(2): 137-146.
14.	Wheatley DP, van Moffaert M, Timmerman L, et al. Mirtazapine: efficacy and tolerability in comparison with fluoxetine in patients with moderate to severe major depressive disorder. Mirtazapine- Fluoxetine Study Group. J Clin Psychiatry, 1998, 59(6): 306-312.
15.	Hong CJ, Hu WH, Chen CC, et al. A double-blind, randomized, group-comparative study of the tolerability and efficacy of 6 weeks’ treatment with mirtazapine or fluoxetine in depressed Chinese patients. J Clin Psychiatry, 2003, 64(8): 921-926v.
16.	张纪水, 刘铁桥, 赵靖平, 等. 米氮平与氟西汀治疗抑郁症的对照研究. 中国临床康复, 2003, 7(30): 4102-4104.
17.	Winokur A, DeMartinis NA 3rd, McNally DP, et al. Comparative effects of mirtazapine and fluoxetine on sleep physiology measures in patients with major depression and insomnia. J Clin Psychiatry, 2003, 64(10): 1224-1229.
18.	de Boer T. The pharmacologic profile of mirtazapine. J Clin Psychiatry, 1996, 57(Suppl 4): 19-25.
19.	de Boer T, Nefkens F, Van Helvoirt A, et al. The alpha 2-adrenoceptor antagonist Org 3770 enhances serotonin transmission in vivo. Eur J Pharmacol, 1994, 253(1-2): R5-6.
20.	Haddjeri N, Blier P, de Montigny C, et al. Noradrenergic modulation of central serotonergic neurotransmission:acute and long-term actions of mirtazapine. Int Clin Psychopharmacol, 1995, (10 Suppl 4): 11-7.
21.	Shen J, Chung SA, Kayumov L, et a1. Polysomographic and symptomatological analyses of major depressive disorder patients treated with mirtazapine. Can J Psychiatry, 2006, 51(1): 27-34.
22.	Schmid DA, Wiehniak A, Uhr M, et a1. Changes of sleep architecture, spectral composition of sleep EEG, the nocturnal secretion of cortisol, ACTH, GH, Prolactin, melatonin, ghrelin, and leptin, and the DEX-CRH test in depressed patients during treatment with mirtazapine. Neuropsychopharmacology, 2006, 31(4): 832-844.
23.	Herman JB, Brotman AW, Pollack MH, et al. Fluoxetine-induced sexual dysfunction. J Clin Psychiatry, 1990, 51(1): 25-27.
24.	Kline MD. Fluoxetine and anorgasmia. Am J Psychiatry, 1989, 146(6): 804-805.
25.	Musher JS. Anorgasmia with the use of fluoxetine. Am J Psychiatry, 1990, 147(7): 948.
26.	Goodnick PJ, Kremer C, Wingard P, et al. Weight change during mirtazapine therapy. Prim Psychiatry, 1998, 3: 103-108.
27.	Gartlehner G, Gaynes BN, Hansen RA, et al. Comparative benefits and harms of second-generation antidepressants: background paper for the American College of Physicians. Ann Intern Med, 2008, 149(10): 734-750.

1. Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020:Global Burden of Disease Study.Lancet, 1997, 349(9064): 1498-1504.
2. Sonawalla SB, Fava M. Severe depression:is there a best approach? CNS Drugs, 2001, 15(10): 765-776.
3. Thomas CM, Morris S. Cost of depression among adults in England in 2000. Br J Psychiatry, 2003, 183: 514-519.
4. Wang PS, Simon G, Kesler RC, et al. The economic burden of depression and the cost-effectiveness of treatment. Int J Methods Psychiatry Res, 2003, 12(1): 22-33.
5. de Boer T. The effects of mirtazapine on central noradrenergic and serotonergic neurotransmission. Int Clin Psychopharmacol, 1995, 10(Suppl 4): 19-23.
6. Benkert O, Szegedi A, Kohnen R, et al. Mirtazapine compared with paroxetine in major depression. J Clin Psychiatry, 2000, 61(9): 656-663.
7. Kasper S. Clinical efficacy of mirtazapine:a review of meta-analyses of pooled data. Int Clin Psychopharmacol, 1995, 10(Suppl 4): 25-35.
8. Watanabe N, Omori IM, Nakagawa A, et al. Mirtazapine versus other antidepressants in the acute-phase treatment of adults with major depression: systematic review and meta-analysis. J Clin Psychiatry, 2008, 69(9): 1404-1415.
9. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry, 1960, 23: 56-62.
10. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials:is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
11. Schulz KF, Chalmers I, Hayes RJ, et al. Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA, 1995, 273(5): 408-412.
12. Amini H, Aghayan S, Jalili SA, et al. Comparison of mirtazapine and fluoxetine in the treatment of major depressive disorder: a doubleblind, randomized trial. J Clin Pharm Ther, 2005, 30(2): 133-138.
13. Versiani M, Moreno R, Ramakers-van Moorsel CJ, et al. Comparative Efficacy Antidepressants Study Group.Comparison of the effects of mirtazapine and fluoxetine in severely depressed patients. CNS Drugs, 2005, 19(2): 137-146.
14. Wheatley DP, van Moffaert M, Timmerman L, et al. Mirtazapine: efficacy and tolerability in comparison with fluoxetine in patients with moderate to severe major depressive disorder. Mirtazapine- Fluoxetine Study Group. J Clin Psychiatry, 1998, 59(6): 306-312.
15. Hong CJ, Hu WH, Chen CC, et al. A double-blind, randomized, group-comparative study of the tolerability and efficacy of 6 weeks’ treatment with mirtazapine or fluoxetine in depressed Chinese patients. J Clin Psychiatry, 2003, 64(8): 921-926v.
16. 张纪水, 刘铁桥, 赵靖平, 等. 米氮平与氟西汀治疗抑郁症的对照研究. 中国临床康复, 2003, 7(30): 4102-4104.
17. Winokur A, DeMartinis NA 3rd, McNally DP, et al. Comparative effects of mirtazapine and fluoxetine on sleep physiology measures in patients with major depression and insomnia. J Clin Psychiatry, 2003, 64(10): 1224-1229.
18. de Boer T. The pharmacologic profile of mirtazapine. J Clin Psychiatry, 1996, 57(Suppl 4): 19-25.
19. de Boer T, Nefkens F, Van Helvoirt A, et al. The alpha 2-adrenoceptor antagonist Org 3770 enhances serotonin transmission in vivo. Eur J Pharmacol, 1994, 253(1-2): R5-6.
20. Haddjeri N, Blier P, de Montigny C, et al. Noradrenergic modulation of central serotonergic neurotransmission:acute and long-term actions of mirtazapine. Int Clin Psychopharmacol, 1995, (10 Suppl 4): 11-7.
21. Shen J, Chung SA, Kayumov L, et a1. Polysomographic and symptomatological analyses of major depressive disorder patients treated with mirtazapine. Can J Psychiatry, 2006, 51(1): 27-34.
22. Schmid DA, Wiehniak A, Uhr M, et a1. Changes of sleep architecture, spectral composition of sleep EEG, the nocturnal secretion of cortisol, ACTH, GH, Prolactin, melatonin, ghrelin, and leptin, and the DEX-CRH test in depressed patients during treatment with mirtazapine. Neuropsychopharmacology, 2006, 31(4): 832-844.
23. Herman JB, Brotman AW, Pollack MH, et al. Fluoxetine-induced sexual dysfunction. J Clin Psychiatry, 1990, 51(1): 25-27.
24. Kline MD. Fluoxetine and anorgasmia. Am J Psychiatry, 1989, 146(6): 804-805.
25. Musher JS. Anorgasmia with the use of fluoxetine. Am J Psychiatry, 1990, 147(7): 948.
26. Goodnick PJ, Kremer C, Wingard P, et al. Weight change during mirtazapine therapy. Prim Psychiatry, 1998, 3: 103-108.
27. Gartlehner G, Gaynes BN, Hansen RA, et al. Comparative benefits and harms of second-generation antidepressants: background paper for the American College of Physicians. Ann Intern Med, 2008, 149(10): 734-750.

上一篇
丁苯酞治疗急性缺血性卒中随机对照试验的系统评价
下一篇
缺血预处理对器官保护作用的文献分析

《中国循证医学杂志》

米氮平与氟西汀治疗成人抑郁症疗效及安全性的Meta分析

摘要 全文 图表 视频 参考文献 施引文献 补充材料

上一篇

下一篇

Format

Content

《中国循证医学杂志》

米氮平与氟西汀治疗成人抑郁症疗效及安全性的Meta分析

摘要 全文 图表 视频 参考文献 施引文献 补充材料

上一篇

下一篇

Format

Content

摘要全文图表视频参考文献施引文献补充材料