米氮平與氟西汀治療成人抑郁癥療效及安全性的Meta分析_《中國循證醫學雜志》

作者：

1. 安徽醫科大學附屬安徽省立醫院(合肥 230001);2. 四川大學華西醫院中國循證醫學中心(成都 610041);3. 安徽醫科大學臨床藥理研究所(合肥 230032);

關鍵詞：

米氮平氟西汀抑郁癥 Meta 分析

DOI：

10.7507/1672-2531.20100385

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目的　系統評價米氮平與氟西汀比較治療成人抑郁癥的療效及不良反應。
方法　計算機檢索 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)、萬方數據庫(1980 ~ 2008 年 12 月),納入米氮平與氟西汀比較治療成年抑郁癥的隨機對照試驗(RCT),對納入 RCT 進行質量評價,采用 RevMan 5.0 軟件進行 Meta 分析。
結果　共納入 5 個 RCT,包括 695 例抑郁癥患者。Meta 分析結果顯示:1 治療后 1 周和 2 周米氮平組的有效性均顯著高于氟西汀組[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];但治療 6 周后米氮平組與氟西汀組的有效性差異無統計學意義[RR=1.21,95%CI(0.89,1.63),P=0.23]; 第 6 周治愈率米氮平組略高于氟西汀組[RR=1.40,95%CI(1.09,1.80),P=0.009]。2 不良反應:米氮平組的嗜睡、體重增加發生率高于氟西汀組[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], 惡心、失眠發生率低于氟西汀組[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], 其余常見不良反應差異無統計學意義(P gt;0.05)。
結論　米氮平抗抑郁療效優于氟西汀且起效較快,在常見不良反應中,米氮平更易引起嗜睡及體重增加,氟西汀更易引起惡心及失眠,其余不良反應兩組差異無統計學意義。

引用本文： 周冉,徐維平,王莉,徐婷娟,胡世蓮,嚴光,魏偉,李幼平. 米氮平與氟西汀治療成人抑郁癥療效及安全性的Meta分析. 中國循證醫學雜志, 2010, 10(2): 196-202. doi: 10.7507/1672-2531.20100385 復制

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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.	張紀水, 劉鐵橋, 趙靖平, 等. 米氮平與氟西汀治療抑郁癥的對照研究. 中國臨床康復, 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. 張紀水, 劉鐵橋, 趙靖平, 等. 米氮平與氟西汀治療抑郁癥的對照研究. 中國臨床康復, 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.

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