摘要
目的评价在预防产后抑郁中,除临床标准护理外,不同抗抑郁药物治疗的有效性。比较不同抗抑郁药物与其他抗产后抑郁干预措施如激素、心理治疗或社会支持的有效性,以及抗抑郁药物在母亲和胎儿或婴儿中的不良反应。方法检索在Cochrane抑郁小组、焦虑与神经官能症小组、Cochrane妊娠和分娩小组中注册和更新的临床试验。在原无抑郁症的孕妇或在最近6周内妊娠的妇女(即产后抑郁的危险人群)中进行的,与安慰剂或心理治疗比较,单用抗抑郁药或与其他治疗联合的临床随机对照研究。试验报告数据的提取由作者独立进行。如有可能,向原作者索取缺失的信息,并寻找数据以便进行ITT分析。结果本系统评价共纳入2个符合纳入标准的试验。研究对象均为曾有产后抑郁病史妇女。Wisner2001的研究显示,去甲替林组(n=26)的疗效并不优于安慰剂组(n=25)。Wisner2004的研究显示,舍曲林组(n=14)与安慰剂组(n=8)比较,减少了产后抑郁症的再次发生,缩短了再次发病的时间。未能对任何一个试验进行ITT分析。结论对于产后立即给与抗抑郁药预防产后抑郁的确切疗效,目前尚无法得出任何结论。因此不推荐在预防产后抑郁时使用。尚需进行抗抑郁药物与其他预防措施比较的更大规模的试验来反映临床实践情况,调查其对胎儿或婴儿的不良反应,并评价妇女对在此阶段使用抗抑郁药物的看法。
Objectives To evaluate the effectiveness of different antidepressant drugs in addition to standard clinical care in the prevention of postnatal depression. To compare the effectiveness of different antidepressant drugs and with any other form of intervention for postnatal depression i.e. hormonal, psychological or social support To assess any adverse effects of antidepressant drugs in either the mother or the foetus/infant Methods The register of clinical trials maintained and updated by the Cochrane Depression, Anxiety and Neurosis Group and the Cochrane Pregnancy and Childbirth Group. Randomised studies of antidepressants alone or in combination with another treatment, compared with placebo or a psychosocial intervention in non-depressed pregnant women or women who had given birth in the previous six weeks （ i.e. women at risk of postuatal depression）. Data were extracted independently from the trial reports by the authors. Missing information was requested from investigators wherever possible Data were sought to allow an intention to treat analysis Results Two trials fullled the inclusion criteria for this review. Both looked at women with a past history of postpartum depression. Nortriptyline （n =26 ） did not show any benefit over placebo （n =25 ）. Sertraline （n = 14 ） reduced the recurrence of postnatal depression and the time to recurrence when compared with placebo （n =8）. Intention to treat analyses were not carried out in either trial. Conclusions It is not possible to draw any clear conclusions about the effectiveness of antidepressants given immediately postpartum in preventing postnatal depression and, therefore, cannot be recommended for prophylaxis of postnatal depression, due to the lack of clear evidence. Larger trials are needed which also include comparisons of antidepressant drugs with other prophylactic treatments to reect clinical practice, and examine adverse effects for the foetus and infant, as well as assess womens＇ attitudes to the use of antidepressants at this time.
出处
《中国循证医学杂志》
CSCD
2005年第10期735-742,共8页
Chinese Journal of Evidence-based Medicine
关键词
产后抑郁
抗抑郁药
系统评价
疗效
安全性
Antidepressant drugs
Postnatal depression
Systematic review
Effectiveness
Safety
