A meta-analysis of the potential antidepressant effects of buprenorphine versus placebo as an adjunctive pharmacotherapy for treatment-resistant depression

被引:12
作者
Dinoff, Adam [1 ]
Lynch, Sean T. [1 ]
Sekhri, Nitin [1 ,2 ]
Klepacz, Lidia [1 ,3 ]
机构
[1] New York Med Coll, Sch Med, 40 Sunshine Cottage Rd, Valhalla, NY 10595 USA
[2] Westchester Med Ctr, Dept Anesthesiol, Valhalla, NY 10595 USA
[3] Westchester Med Ctr, Dept Psychiat, Valhalla, NY 10595 USA
关键词
Depressive disorders; Treatment-resistant depression; Buprenorphine; Meta-analysis; MU-OPIOID RECEPTOR; RANDOM-EFFECTS MODELS; MONTGOMERY-ASBERG; MAJOR DEPRESSION; DISORDER; PREVALENCE; MANAGEMENT; RESPONSES; OUTCOMES; ADULTS;
D O I
10.1016/j.jad.2020.03.089
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background: Numerous reports have suggested that buprenorphine may have antidepressant effects. Many individuals with depressive disorders don't respond to first-line treatment and are classified with treatment-resistant depression (TRD). Novel therapies for depression are required to better treat this population. This meta-analysis of randomized placebo-controlled trials sought to evaluate the potential antidepressant effects of buprenorphine as an adjunctive pharmacological treatment for individuals with TRD. Methods: PubMed, Embase, CINAHL, Web of Science, and ClinicalTrials.gov databases were searched until June 2019 for original peer-reviewed reports of buprenorphine used for the treatment of depression. Standardized mean differences (SMD) were generated from random effects models. Risk of publication bias was assessed using a funnel plot. Potential sources of heterogeneity were explored in subgroup analyses. Results: In six studies that met inclusion criteria, depression symptom severity in individuals with TRD was not significantly decreased after an adjunctive intervention with buprenorphine when compared to placebo (SMD = -0.07, 95% CI: -0.21-0.06, p = 0.30). Five of the six studies utilized a combination of buprenorphine/samidorphan. In these studies, depression symptom severity was also not significantly reduced after intervention compared to placebo (SMD = -0.08, 95% CI: -0.21 - 0.05, p = 0.23). Limitations: Five included studies were performed by the same research group with significant conflicts of interest. Conclusions: This meta-analysis did not reveal a significant reduction in depression symptom severity in individuals with TRD after an adjunctive intervention with buprenorphine when compared to placebo. However, more optimal doses of buprenorphine (2 mg/day) and longer treatment lengths should be explored.
引用
收藏
页码:91 / 99
页数:9
相关论文
共 86 条
[1]   Treatment resistant depression: A multi-scale, systems biology approach [J].
Akil, Huda ;
Gordon, Joshua ;
Hen, Rene ;
Javitch, Jonathan ;
Mayberg, Helen ;
McEwen, Bruce ;
Meaney, Michael J. ;
Nestler, Eric J. .
NEUROSCIENCE AND BIOBEHAVIORAL REVIEWS, 2018, 84 :272-288
[2]   Treatment-resistant depression: therapeutic trends, challenges, and future directions [J].
Al-Harbi, Khalid Saad .
PATIENT PREFERENCE AND ADHERENCE, 2012, 6 :369-388
[3]  
[Anonymous], MOL PSYCHIAT
[4]  
[Anonymous], J ADDICT DEPEND
[5]  
[Anonymous], PRIM CARE COMPANION
[6]   Depression and pain comorbidity - A literature review [J].
Bair, MJ ;
Robinson, RL ;
Katon, W ;
Kroenke, K .
ARCHIVES OF INTERNAL MEDICINE, 2003, 163 (20) :2433-2445
[7]   Presynaptic opioid receptors on noradrenergic and serotonergic neurons in the human as compared to the rat neocortex [J].
Berger, Benjamin ;
Rothmaier, Anna Katharina ;
Wedekind, Franziska ;
Zentner, Josef ;
Feuerstein, Thomas J. ;
Jackisch, Rolf .
BRITISH JOURNAL OF PHARMACOLOGY, 2006, 148 (06) :795-806
[8]   What is the meaning of treatment resistant/refractory major depression (TRD)? A systematic review of current randomized trials [J].
Berlim, Marcelo T. ;
Turecki, Gustavo .
EUROPEAN NEUROPSYCHOPHARMACOLOGY, 2007, 17 (11) :696-707
[9]   Effects of Buprenorphine on Responses to Emotional Stimuli in Individuals with a Range of Mood Symptomatology [J].
Bershad, Anya K. ;
Ruiz, Nicholas A. ;
de Wit, Harriet .
INTERNATIONAL JOURNAL OF NEUROPSYCHOPHARMACOLOGY, 2018, 21 (02) :120-127
[10]   Opioid partial agonist buprenorphine dampens responses to psychosocial stress in humans [J].
Bershad, Anya K. ;
Jaffe, Jerome H. ;
Childs, Emma ;
de Wit, Harriet .
PSYCHONEUROENDOCRINOLOGY, 2015, 52 :281-288