Anorexia Nervosa (AN) is an illness characterised by extreme concern about body weight and shape, severe self-imposed weight loss, and endocrine dysfunction. In spite of its high mortality, morbidity and chronicity, there are few intervention studies on the subject.
The aim of this review was to evaluate the efficacy and acceptability of antidepressant drugs in the treatment of acute AN.
The strategy comprised of database searches of the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register, MEDLINE (1966 to April 28th, 2005), EMBASE (1980 to week 36, 2004), PsycINFO (1969 to August week 5, 2004), handsearching the International Journal of Eating Disorders and searching the reference lists of all papers selected. Personal letters were sent to researchers in the field requesting information on unpublished or in-progress trials.
All randomised controlled trials of antidepressant treatment for AN patients, as defined by the Diagnostic and Statistical Manual, fourth edition (DSM-IV) or similar international criteria, were selected.
Data collection and analysis
Quality ratings were made giving consideration to the strong relationship between allocation concealment and potential for bias in the results; studies meeting criteria A and B were included. Trials were excluded if non-completion rates were above 50%. The standardised mean difference and relative risk were used for continuous data and dichotomous data comparisons, respectively. Whenever possible, analyses were performed according to intention-to-treat principles. Heterogeneity was tested with the I-squared statistic. Weight change was the primary outcome. Secondary outcomes were severity of eating disorder, depression and anxiety symptoms, and global clinical state. Acceptability of treatment was evaluated by considering non-completion rates.
Only seven studies were included. Major methodological limitations such as small trial size and large confidence intervals decreased the power of the studies to detect differences between treatments, and meta-analysis of data was not possible for the majority of outcomes. Four placebo-controlled trials did not find evidence that antidepressants improved weight gain, eating disorder or associated psychopathology. Isolated findings, favouring amineptine and nortriptyline, emerged from the antidepressant versus antidepressant comparisons, but cannot be conceived as evidence of efficacy of a specific drug or class of antidepressant in light of the findings from the placebo comparisons. Non-completion rates were similar between the compared groups.
A lack of quality information precludes us from drawing definite conclusions or recommendations on the use of antidepressants in acute AN. Future studies testing safer and more tolerable antidepressants in larger, well designed trials are needed to provide guidance for clinical practice.
策略是搜尋資料庫the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register, MEDLINE (1966 to April 28th, 2005), EMBASE (1980 to week 36, 2004), PsycINFO (1969 to August week 5, 2004)，及手動搜尋the International Journal of Eating Disorders 及尋找所有挑 選文獻的引用文獻。以信件連絡這個領域的研究者以求得未發表技進行中的試驗資料。
挑選所有隨機控制試驗(randomised controlled trials)，其在研究以抗憂鬱劑治療神經性厭食症患者，診斷定義依照Diagnostic and Statistical Manual, fourth edition (DSMIV) 或相似的國際條件。
品質的評量在考量分配的保密及結果有誤差可能性之間的關聯強度；研究須符合條件A及B才納入。試驗的未完成率高於50則被排除。對連續性數據及二分法的數據各自以標準平均差及相對風險來比較。當可行性夠時，以治療意向(intentiontotreat)為分析原則。異質性的測試使用the Isquared statistic。體重變化是主要的結果。第二結果是厭食症的嚴重度、憂鬱及焦慮症狀、整體臨床狀態。治療接受度已考量未完成率來評估。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。