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Tytuł:
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Comparative efficacy and safety of stimulant-type medications for depression: A systematic review and network meta-analysis.
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Autorzy:
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Bahji A; Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; British Columbia Centre for Substance Use, Vancouver, British Columbia, Canada. Electronic address: .
Mesbah-Oskui L; Department of Neurology, University of British Columbia, Vancouver, British Columbia, Canada; Department of Medicine, Queen's University, Kingston, Ontario, Canada.
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Źródło:
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Journal of affective disorders [J Affect Disord] 2021 Sep 01; Vol. 292, pp. 416-423. Date of Electronic Publication: 2021 Jun 15.
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Typ publikacji:
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Journal Article; Meta-Analysis; Review; Systematic Review
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Język:
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English
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Imprint Name(s):
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Original Publication: Amsterdam, Elsevier/North-Holland Biomedical Press.
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MeSH Terms:
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Central Nervous System Stimulants*/adverse effects
Methylphenidate*/adverse effects
Adult ; Depression ; Fatigue ; Humans ; Network Meta-Analysis
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Substance Nomenclature:
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0 (Central Nervous System Stimulants)
207ZZ9QZ49 (Methylphenidate)
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Entry Date(s):
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Date Created: 20210618 Date Completed: 20210805 Latest Revision: 20210805
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Update Code:
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20240104
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DOI:
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10.1016/j.jad.2021.05.119
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PMID:
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34144366
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Background: Globally, depression impacts nearly 300 million people, and roughly half do not achieve remission with standard first-line therapies. For such individuals, augmentation strategies are often helpful at reducing the severity of depression. While there are many potential adjunctive medication choices, psychostimulants are among the more controversial options.
Objectives: The present review sought to clarify the comparative efficacy and safety of different stimulant-like medications to treat depression.
Methods: We conducted a systematic review and network meta-analysis of randomized, controlled trials (RCTs) using psychostimulant medications to treat adults with depression. Outcomes were pooled using rate ratios (RRs) for dichotomous outcomes (e.g., response, adverse events) and standardized mean differences (SMDs) for continuous outcomes (e.g., change in depression scores).
Results: We identified 37 eligible studies (ranging from 1958 to 2016). We assessed nine psychostimulants: methylphenidate (n=14), dextroamphetamine (n=9), modafinil (n=6), lisdexamphetamine (n=3), methylamphetamine (n=3), pemoline (n=2), atomoxetine (n=1), desipramine (n=1), and imipramine (n=1). Overall, psychostimulants demonstrated efficacy for depression, reduced fatigue and sleepiness, and appeared well-tolerated. However, there was inconsistent evidence across particular psychostimulants. For example, the only psychostimulant which demonstrated efficacy for depression-in terms of both symptom severity and response rates-was methylphenidate.
Conclusions: While our review suggests that some psychostimulants-particularly methylphenidate-appear well-tolerated and demonstrate some efficacy for depression, as well as fatigue and sleepiness, the strength of evidence in our estimates was low to very low for most agents given the small sample sizes, few RCTs, and imprecision in most estimates. A lack of consistent evidence precludes a definitive hierarchy of treatments and points to a need for additional, high-quality RCTs.
(Copyright © 2021. Published by Elsevier B.V.)
