三环类抗抑郁药物与选择性5-羟色胺再摄取抑制药治疗抑郁症致失眠焦虑激越与躁狂的Meta分析

Meta-Analysis for Incidence of Insomnia,Anxiety,Irritability and Manic Episode Induced by TCA and SSRIs

目的分析三环类抗抑郁药物（TCA）与选择性5-羟色睦再摄取抑制药（SSRI）治疗抑郁症引发失眠、焦虑、激越与蹂狂的差异。方法应用循证医学的Meta分析，采用固定效应模型（fixed effectsmodel，FEM）法对符合标准的63项对照研究文献进行评价。结果SSRI与TCA治疗抑郁症出现失眠、激越差异有显著性（16％和3．8％，OR=5．05。95％CI：4．06—6．30,x^2=181．7，P〈0．01；8．7％和3．5％，OR=2．80，95％CI：1．82—4．76x^2。=5．09，P〈0．01），但是焦虑、躁狂发作的差异无显著性（10．7％和8．9％，OR=1．75，95％CI：0．99—3．10，x^=2．39，P〉0．05；2．2％和3．8％，OR=1．68，95％CI：0．90—3．13，x^2=1．90，P〉0．05）。结论在治疗抑郁症中，SSRI比TCA更可引发失眠、激越，应特别加以关注。

Objective To compare the incidence of insomnia, anxiety, irritability, and manic episode induced by SSRI and tricyclic antidepressants （TCA）. Methods The 63 standarized literatures were analysed in the fixed effects model by meta-analysis of evidence-based medicine（EBM）. Results The significant difference on incidence of insomnia and irritability were found between SSRI and TCA（16% v 3.8%, OR =5.05, 95%CI： 4.06 -6.30,x^2 = 181.7, P 〈0.01 ; 8.7% v 3.5%, OR = 2.80, 95% CI： 1.82 -4. 76 , x^2 =5.09, P 〈 0.01 ） , but no difference on incidence of anxiety and manic episode induced by fluoxetine and TCA was observed（10.7% v 8.9%, OR = 1.75, 95% CI： 0.99 - 3.10, x^2 = 2.39, P 〉 0.05; 2.2% v 3.8%, OR=1.68, 95%CI： 0.90-3.13,x^2 =1.90, P〉0.05）. Conclusion Attention should be paid on insomnia, irritability generated by the treatment with SSRI, since more incidence developed by SSRI than TCA during treatment for depression.