Hostname: page-component-84b7d79bbc-2l2gl Total loading time: 0 Render date: 2024-07-28T12:11:35.142Z Has data issue: false hasContentIssue false
  • English
  • Français

Metanálisis de ensayos clínicos que compararon los antagonistas de los receptores de serotonina (5HT)-2 trazodona y nefazodona con inhibidores selectivos de la recaptación de serotonina para el tratamiento del trastorno depresivo mayor

Published online by Cambridge University Press:  12 May 2020

George I. Papakostas  and
Maurizio Fava
George I. Papakostas
Affiliation:
Departamento de Psiquiatría, Programa de Depresión Clínica e Investigación, Hospital General de Massachusetts, Facultad de Medicina de Harvard, 15 Parkman Street, WAC 812, Boston, MA 02114, Estados Unidos
Maurizio Fava
Affiliation:
Departamento de Psiquiatría, Programa de Depresión Clínica e Investigación, Hospital General de Massachusetts, Facultad de Medicina de Harvard, 15 Parkman Street, WAC 812, Boston, MA 02114, Estados Unidos
Get access

Resumen

Objetivo.

Comparar las tasas de respuesta de pacientes con trastorno depresivo mayor (TDM) tratados con un antagonista de los receptores de serotonina-2 (5HT2) o un inhibidor selectivo de la recaptación de serotonina (ISRS).

Métodos.

Se buscaron en Medline y PubMed todos los ensayos doble ciegos, clínicos y aleatorizados que compararon trazodona o nefazodona con un ISRS para el tratamiento del TDM. Se recogieron datos de 9 artículos con un total de 988 pacientes y se combinaron usando un modelo de efectos aleatorios.

Resultados.

Los pacientes aleatorizados para un tratamiento con un antagonista de 5HT2 tenían tantas probabilidades de conseguir una respuesta clínica como los pacientes aleatorizados al tratamiento con un ISRS (RR = 1,002, IC 95%: 0,85-1,17, P = 0,978). Las tasas de respuesta agrupadas para trazodona/nefazodona y para el ISRSS fueron 61,1% y 61,7%, respectivamente. No hubo ninguna diferencia en las tasas de suspensión total del tratamiento (P = 0,334), suspensión debida a efectos secundarios (P = 0,676) o suspensión debida a la ineficacia (P = 0,289) entre los dos grupos.

Conclusiones.

Estos resultados sugieren que los antagonistas de los receptores 5HT2 -trazodona y nefazodona- y los ISRSS no se diferencien en su eficacia y tolerabilidad total para el tratamiento del TDM. Aunque el tamaño de la muestra fue relativamente grande y tuvo poder estadístico suficiente para probar las diferencias en la muestra total, la depresión es una enfermedad heterogénea y pueden existir diferencias entre los tratamientos en los distintos subgrupos de pacientes.

Keywords

5HT2ISRSTrazodonaNefazodonaDepresión
Type
Artículo original
Information
European Psychiatry (Ed. Española) , Volume 15 , Issue 1 , February 2008 , pp. 18 - 22
Copyright
Copyright © European Psychiatric Association 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bibliografía

Anderson, IM. Selective serotonin reuptake inhibitors versus tricyclic antidepressants: a meta-analysis of efficacy and tolerability. J Affect Disord 2000;58(1): 19–36.CrossRefGoogle ScholarPubMed
Armitage, R, Yonkers, K, Cole, D, Rush, AJ. A multicenter, double-blind comparison of the effects of nefazodone and fluoxetine on sleep architecture and quality of sleep in depressed outpatients. J Clin Psychopharmacol 1997; 17(3): 161 -8.CrossRefGoogle ScholarPubMed
Avila, A, Cardona, X, Martin-Baranera, M, Maho, P, Sastre, F, Bello, J. Does nefazodone improve both depression and Parkinson disease? A pilot randomized trial. J Clin Psychopharmacol 2003;23(5):509–13.CrossRefGoogle ScholarPubMed
Baldwin, DS, Hawley, CJ, Abed, RT, Maragakis, BP, Cox, J, Buckingham, SA, et al. A multicenter double-blind comparison of nefazodone and paroxetine in the treatment of outpatients with moderate-tosevere depression. J Clin Psychiatry 1996;57(s(2)):46–52.Google Scholar
Beasley, CM Jr, Dornseif, BE, Pultz, JA, Bosomworth, JC, Sayler, ME. Fluoxetine versus trazodone: efficacy and activating-sedating effects. J Clin Psychiatry 1991 ;52(7):294–9.Google ScholarPubMed
Berlanga, C, Arechevaleta, B, Heinze, G. A double-blind comparison of nefazodone and fluoxetine in the treatment of depressed outpatients. Salud Mental 1997;20:1–8.Google Scholar
Debus, JR, Rush, AJ, Himmel, C, Tyler, D, Polatin, P, Weissenburger, J. Fluoxetine versus trazodone in the treatment of outpatients with major depression. J Clin Psychiatry 1988;49(11):422–6.Google ScholarPubMed
DerSimonian, R, Laird, N. Meta-analysis in clinical triais. Control Clin Trials 1986;7:177–88.CrossRefGoogle Scholar
Falk, WE, Rosenbaum, JF, Otto, MW, Zusky, PM, Weilburg, JB, Nixon, RA. Fluoxetine versus trazodone in depressed geriatric patients. J Geriatr Psychiatry Neurol 1989;2(4):208–14.Google ScholarPubMed
Feiger, A, Kiev, A, Shrivastava, RK, Wisselink, PG, Wilcox, CS. Nefazodone versus sertraline in outpatients with major depression: focus on efficacy, tolerability, and effects on sexual function and satisfaction. J Clin Psychiatry 1996;57(s(2)):53–62.Google ScholarPubMed
Ferguson, JM, Shrivastava, RK, Stahl, SM, Hartford, JT, Borian, F, Ieni, J, et al. Reemergence of sexual dysfunction in patients with major depressive disorder: double-blind comparison of nefazodone and sertraline. J Clin Psychiatry 2001;62(1):24–9.CrossRefGoogle ScholarPubMed
Fudge, JL, Perry, PJ, Garvey, MJ, Kelly, MW. A comparison of the effect of fluoxetine and trazodone on the cognitive functioning of depressed outpatients. J Affect Disord 1990;18(4):275–80.CrossRefGoogle ScholarPubMed
Gillin, JC, Rapaport, M, Erman, MK, Winokur, A, Albala, BJ. A comparison of nefazodone and fluoxetine on mood and on objective, subjective, and clinician-rated measures of sleep in depressed patients: a double-blind, 8-week clinical trial. J Clin Psychiatry 1997;58(5): 185–92.CrossRefGoogle ScholarPubMed
Guy, W, editor. ECDEU Assessment manual for psychopharmacology, revised. Rockville, MD: National Institute of Mental Health; 1976. DHEW Pub. No. (ADM) 76-338.Google Scholar
Hamilton, M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56–62.CrossRefGoogle ScholarPubMed
Hicks, JA, Argyropoulos, SV, Rich, AS, Nash, JR, Bell, CJ, Edwards, C, et al. Randomised controlled study of sleep after nefazodone or paroxetine treatment in out-patients with depression. Br J Psychiatry 2002;180:528–35.CrossRefGoogle ScholarPubMed
Kasper, S, Olie, R. A meta-analysis of randomized controlled trials of tianeptine versus SSRI in the short-term treatment of depression. Eur Psychiatry 2002;17(Suppl. 3):331–40.CrossRefGoogle ScholarPubMed
Kasper, S, Olivieri, L, Di Loreto, G, Dionisio, P. A comparative, randomised, double-blind study of trazodone prolonged-release and paroxetine in the treatment of patients with major depressive disorder. Curr Med Res Opin 2005;21(8): 1139–46.CrossRefGoogle ScholarPubMed
Laird, NM, Mosteller, F. Some statistical methods for combining experimental results. Int J Technol Assess Health Care 1990;6:5–30.CrossRefGoogle ScholarPubMed
Montgomery, SA, Asberg, A. A new depression scale designed to be sensitive to change. Br J Psychiatry 1979;134:382–9.CrossRefGoogle ScholarPubMed
Mosteller, F, Colditz, GA. Understanding research synthesis (meta-analysis). Annu Rev Public Health 1996;17:1–23.CrossRefGoogle Scholar
Munizza, C, Olivieri, L, Di Loreto, G, Dionisio, P. A comparative, randomized, double-blind study of trazodone prolonged-release and sertraline in the treatment of major depressive disorder. Curr Med Res Opin 2006;22(9):1703–13.CrossRefGoogle ScholarPubMed
Nelson, JC. A review of the efficacy of serotonergic and noradrenergic reuptake inhibitors for treatment of major depression. Biol Psychiatry 1999;46(9): 1301–8.CrossRefGoogle ScholarPubMed
Papakostas, GI, Fava, M. Monoamine-based pharmacotherapy. In: Licinio, J, editor. Biology of depression: from novel insights to therapeutic strategies. 1st ed. Weinheim: Wiley-VCH; 2005. p. 87–140.CrossRefGoogle Scholar
Papakostas, GI. Dopaminergic-based pharmacotherapies for depression. Eur Neuropsychopharmacol 2006;16(6):391–402.CrossRefGoogle ScholarPubMed
Papakostas, GI, Fava, M. Does the probability of receiving placebo influence the likelihood of responding to placebo or clinical trial outcome? A meta-regression of double-blind, randomized clinical triais in MDD. Neuropsychopharmacology 2006;31(s1):s158.Google Scholar
Papakostas, GI. Dopaminergic-based pharmacotherapies for depression. Eur Neuropsychopharmacol 2006;16(6):391–402.CrossRefGoogle ScholarPubMed
Papakostas, GI, Fava, M. A meta-analysis of clinical triais comparing moclobemide with selective serotonin reuptake inhibitors for the treatment of major depressive disorder. Can J Psychiatry 2006;51 (12):783–90.CrossRefGoogle Scholar
Papakostas, GI, Homberger, CH, Fava, M. A meta-analysis of clinical trials comparing mirtazapine with a selective serotonin reuptake inhibitor for the treatment of major depressive disorder. J Psychopharmacol, in pressGoogle Scholar
Perry, PJ, Garvey, MJ, Kelly, MW, Cook, BL, Dunner, FJ, Winokur, G. A comparative trial of fluoxetine versus trazodone in outpatients with major depression. J Clin Psychiatry 1989;50(8):290–4.Google ScholarPubMed
Petersen, T, Papakostas, GI, Posternak, MA, Kant, A, Guyker, WM, Iosifescu, DV, et al. Empirical testing of two models for staging anti-depressant treatment resistance. J Clin Psychopharmacol 2005;25(4):336–41.CrossRefGoogle Scholar
Rush, AJ, Armitage, R, Gillin, JC, Yonkers, KA, Winokur, A, Moldofsky, H, et al. Comparative effects of nefazodone and fluoxetine on sleep in outpatients with major depressive disorder. Biol Psychiatry 1998;44(1):3–14.CrossRefGoogle ScholarPubMed
Sterne, JA, Gavaghan, D, Egger, M. Publication and related bias in metaanalysis: power of statistical tests and prevalence in the literature. J Clin Epidemiol 2000;53(11): 1119–29.CrossRefGoogle ScholarPubMed
Thase, ME, Lu, Y, Joliat, MJ, Detke, MJ. Remission in placebo-controlled trials of duloxetine with an SSRI comparator. American Psychiatric Association Annual Meeting; 2003.Google Scholar