ObjectiveTo systematically review the efficacy and safety of selective serotonin reuptake inhibitors (SSRIs) in the treatment of Parkinson's disease patients with depression. MethodsThe Cochrane Library (Issue 5, 2014), PubMed, EMbase, CNKI, VIP and WanFang Data databases were searched from inception to May 2014 for randomized controlled trials (RCTs) investigating the efficacy and safety of SSRIs for Parkinson's disease patients with depression. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2 software. ResultsA total of 12 RCTs were included. The results of meta-analysis showed that the efficacy of SSRIs was better than placebo (RR=2.18, 95%CI 1.60 to 2.97, P<0.000 01) and the dropouts rates of SSRIs were higher than placebo (OR=3.02, 95%CI 1.04 to 8.79, P=0.04). However, the incidence rate of adverse events between the SSRIs group and the placebo group was not statistically different. ConclusionCurrent evidence indicates that SSRIs are effective for the Parkinson's disease patients with depression. Because of the limitation of quantity and quality of included studies, large-scale multi-center RCTs are required to confirm these findings.
ObjectiveTo systematically review the antidepressant efficacy of selective serotonin re-uptake inhibitors (SSRIs) and their effect on inflammatory factors in adults with major depressive disorder (MDD). MethodsElectronic searches were conducted in PubMed, Embase, Web of Science Core Collection, ProQuest, JSTOR, PsycINFO, Cochrane Library, Epistemonikos, CNKI, and CBM databases from inception to December 31, 2024. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Meta-analysis was performed using R 4.4.2 software. ResultsA total of 62 controlled studies (including 63 reports) was included, consisting of 36 randomized controlled trials, 4 non-randomized controlled trials, and 23 case-control studies. Meta-analysis showed that the overall antidepressant effect size of SSRIs was SMD=?3.18 (95%CI ?3.56 to ?2.80), with no statistically significant difference in efficacy between different SSRIs (P=0.24). However, their antidepressant efficacy was influenced by the country of origin of the study participants and the duration of intervention. SSRIs exerted significant inhibitory effects on 17 pro-inflammatory factors, but with high heterogeneity. SSRIs had no significant overall effect on anti-inflammatory factors (SMD=0.81, 95%CI ?0.20 to 1.82). However, subgroup analysis revealed that escitalopram exerted significant promoting effects on IL-10 (SMD=1.11, 95%CI 0.61 to1.60) and IL-13 (SMD=2.40, 95%CI 1.84 to 2.95). ConclusionSSRIs are effective antidepressants but vary in their effects on inflammatory factors. Among them, escitalopram has a potential bidirectional regulatory effect on inflammatory factors, and more high-quality multicenter studies are needed in the future for verification.
Objective To analyze the characteristics and risk factors of hemorrhagic adverse events (AEs) associated with selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). Methods AEs reports with SSRIs/SNRIs as the primary suspected (PS) drugs from the first quarter of 2009 to the third quarter of 2024 in the FAERS database were extracted. Hemorrhagic AEs reports were screened using the MedDRA standard terminology (SMQ). Descriptive statistics were used to analyze patient characteristics, and signal detection was performed using the reporting odds ratio (ROR), proportional reporting ratio (PRR), and the polynomial gamma Poisson distribution reduction method (MGPS). Multiplicative and additive models were used to assess the interaction risk with antiplatelet/anticoagulant drugs. Results A total of 5 073 reports of hemorrhagic AEs associated with SSRIs (6.5%) and 2 740 reports related to SNRIs (4.1%) were included. The proportion of patients aged ≥65 years (P<0.001), the time-to-onset >90 days (P<0.001), reports from healthcare professionals (P<0.001), and serious adverse events (P<0.001) were higher. The gastrointestinal tract and central nervous system were the main bleeding sites for SSRIs, among which sertraline had the most signals for gastrointestinal adverse events, while the central nervous system had the fewest. All positive signals for SNRIs were associated with venlafaxine. Among AEs of various SSRIs/SNRIs combined with other drugs, the proportion of hemorrhagic AEs was higher in the combination with antiplatelet or anticoagulant drugs (P<0.001). Conclusion Hemorrhagic adverse events associated with SSRIs/SNRIs are mostly severe. In clinical practice, it is essential to implement proper pharmaceutical care, focusing on the bleeding risks associated with SSRIs/SNRIs use in elderly patients, those on long-term medication regimens, and patients concurrently using anticoagulants. Individualized medication regimens should be implemented based on the patient's underlying diseases and drug characteristics.