药物结合心理疗法治疗产后抑郁的疗效与安全性：系统评价与Meta分析

Efficacy and Safety of Medication Combined with Psychotherapy in the Treatment of Postpartum Depression: A Systematic Review and Meta-Analysis

摘要: 目的：药物结合心理疗法是一种新型的产后抑郁治疗方法，目前已有许多相关的临床研究发表，本研究旨在系统评价与荟萃分析药物结合心理疗法治疗产后抑郁的疗效与安全性。方法：在PubMed、Embase、Cochrane Library、中国知网数据库(CNKI)、万方数据知识服务平台(WanFang)以及维普中文期刊服务平台(VIP)数据库以中文或英文检索发表的随机对照实验。使用“产后抑郁”、“药物”、“心理疗法”等关键词检索数据库。使用Cochrane Reviewers Handbook 5.1.0作为偏倚风险评估工具，对纳入的43项研究进行风险及质量评价。使用Rev Man 5.3.0与Stata 14.0软件进行荟萃分析、敏感性分析和发表偏倚检验。结果：系统评价与荟萃分析的结果显示，药物结合心理疗法能显著提高产后抑郁的总有效率[OR = 4.88, 95% CI (3.67, 6.47), P < 0.00001]、生活质量水平[SMD = 1.77, 95% CI (1.01, 2.52), P < 0.00001]、5-羟色胺 (5-HT)水平[MD = 1.83, 95% CI (1.11, 2.55), P < 0.00001]，能显著降低三种抑郁量表：汉密顿抑郁量表(HAMD)、Edinburgh产后抑郁量表(EPDS)、汉密尔顿焦虑量表(HAMA)的评分，但对不良反应发生率[OR = 0.92, 95% CI (0.48, 1.78), P = 0.81]无显著影响。结论：药物结合心理疗法能提高对产后抑郁疾病的疗效，但药物结合心理疗法与单一药物治疗在安全性方面并无显著差异。

Abstract: Objective: Drug combined psychotherapy is a new treatment method for postpartum depression, and many related clinical studies have been published. This study aims to systematically evaluate and meta-analyze the efficacy and safety of drug combined psychotherapy in the treatment of postpartum depression. Methods: Randomized controlled trials published in Chinese or English were searched in PubMed, Embase, Cochrane Library, CNKI Database, WanFang Data Knowledge Service Platform (WanFang) and VIP Chinese Journal Service Platform (VIP). Keywords such as “postpartum depression”, “medication” and “psychotherapy” were used to search the database. Using Cochrane Reviewers Handbook 5.1.0 as a risk assessment tool for bias, we evaluated the risk and quality of the 43 included studies. Meta-analysis, sensitivity analysis and publication bias test were performed using Rev Man 5.3.0 and Stata 14.0 software. Results: Meta-analysis showed that Medication combined with psychotherapy can significantly improve the total effective rate of postpartum depression [OR = 4.88, 95% CI (3.67, 6.47), P < 0.00001], quality of life level [SMD = 1.77, 95% CI (1.01, 2.52), and quality of life [SMD = 1.88, 95% CI (1.01, 2.52). P < 0.00001], 5-hydroxytryptamine (5-HT) level [MD = 1.83, 95% CI (1.11, 2.55), P < 0.00001], can significantly reduce three depression scales: The scores of Hamilton Depression Scale (HAMD), Edinburgh Postpartum Depression Scale (EPDS) and Hamilton Anxiety Scale (HAMA) had no significant effect on the incidence of adverse reactions [OR = 0.92, 95% CI (0.48, 1.78), P = 0.81]. Conclusion: Drug combined psychotherapy can improve the efficacy of postpartum depression, but there is no significant difference in safety between drug combined psychotherapy and single drug therapy.