دورية أكاديمية
أعرض في EDS

Clinical interventions for adults with comorbid alcohol use and depressive disorders: A systematic review and network meta-analysis.

التفاصيل البيبلوغرافية
العنوان: Clinical interventions for adults with comorbid alcohol use and depressive disorders: A systematic review and network meta-analysis.
المؤلفون: Grant S; Department of Social & Behavioral Sciences, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, United States of America.; RAND Corporation, Santa Monica, California, United States of America., Azhar G; RAND Corporation, Santa Monica, California, United States of America., Han E; RAND Corporation, Santa Monica, California, United States of America., Booth M; RAND Corporation, Santa Monica, California, United States of America., Motala A; RAND Corporation, Santa Monica, California, United States of America., Larkin J; RAND Corporation, Pittsburgh, Pennsylvania, United States of America., Hempel S; RAND Corporation, Santa Monica, California, United States of America.
المصدر: PLoS medicine [PLoS Med] 2021 Oct 08; Vol. 18 (10), pp. e1003822. Date of Electronic Publication: 2021 Oct 08 (Print Publication: 2021).
نوع المنشور: Journal Article; Meta-Analysis; Research Support, U.S. Gov't, Non-P.H.S.; Systematic Review
اللغة: English
بيانات الدورية: Publisher: Public Library of Science Country of Publication: United States NLM ID: 101231360 Publication Model: eCollection Cited Medium: Internet ISSN: 1549-1676 (Electronic) Linking ISSN: 15491277 NLM ISO Abbreviation: PLoS Med Subsets: MEDLINE
أسماء مطبوعة: Original Publication: San Francisco, CA : Public Library of Science, [2004]-
مواضيع طبية MeSH: Alcoholism/*epidemiology , Depression/*epidemiology, Adult ; Alcoholism/psychology ; Comorbidity ; Depression/psychology ; Female ; Humans ; Male ; Middle Aged ; Publication Bias ; Quality of Life ; Remission Induction ; Risk ; Substance Withdrawal Syndrome/psychology
مستخلص: Background: Uncertainty remains regarding the effectiveness of treatments for patients diagnosed with both an alcohol use disorder (AUD) and depressive disorder. This study aimed to compare the effectiveness of clinical interventions for improving symptoms of adults with co-occurring AUDs and depressive disorders.
Methods and Findings: We searched CINAHL, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Excerpta Medica Database, International Clinical Trials Registry Platform (ICTRP), PubMed, PsycINFO, and Web of Science from inception to December 2020. We included randomized controlled trials (RCTs) evaluating clinical interventions for adults with co-occurring AUDs and depressive disorders. Two independent reviewers extracted study-level information and outcome data. We assessed risk of bias using the Cochrane Risk of Bias tool, used frequentist random effects models for network meta-analyses, and rated our confidence in effect estimates using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Primary outcomes were remission from depression and alcohol use. Secondary outcomes were depressive symptoms, alcohol use, heavy drinking, health-related quality of life, functional status, and adverse events. We used standardized mean differences (SMDs) for continuous outcomes and odds ratios (ORs) for dichotomous outcomes to estimate intervention effects. Overall, 36 RCTs with 2,729 participants evaluated 14 pharmacological and 4 psychological interventions adjunctive to treatment as usual (TAU). Studies were published from 1971 to 2019, conducted in 13 countries, and had a median sample size of 50 participants (range: 14 to 350 participants). We have very low confidence in all estimates of intervention effects on our primary outcomes (i.e., remission from depression and remission from alcohol use). We have moderate confidence that cognitive behavioral therapies (CBTs) demonstrated greater benefit than no additional treatment (SMD = -0.84; 95% confidence interval [CI], -1.05 to -0.63; p < 0.001) for depressive symptoms and low confidence (SMD = -0.25; 95% CI, -0.47 to -0.04; p = 0.021) for alcohol use. We have low confidence that tricyclic antidepressants (TCAs) demonstrated greater benefit than placebo (SMD = -0.37; 95% CI, -0.72 to -0.02, p = 0.038) for depressive symptoms. Compared with placebo, we have moderate confidence that selective serotonin reuptake inhibitors (SSRIs) demonstrated greater benefit for functional status (SMD = -0.92; 95% CI, -1.36 to -0.47, p < 0.001) and low confidence for alcohol use (SMD = -0.30; 95% CI, -0.59 to -0.02, p = 0.039). However, we have moderate confidence that patients receiving SSRIs also were more likely to experience an adverse event (OR = 2.20; 95% CI, 0.94 to 5.16, p = 0.07). We have very low confidence in all other effect estimates, and we did not have high confidence in any effect estimates. Limitations include the sparsity of evidence on intervention effects over the long term, risks of attrition bias, and heterogeneous definitions of adverse events in the evidence base.
Conclusions: We are very uncertain about the existence (or not) of any non-null effects for our primary outcomes of remission from depression and remission from alcohol use. The available evidence does suggest that CBTs likely reduced, and TCAs may have resulted in a slight reduction of depressive symptoms. SSRIs likely increased functional status, and SSRIs and CBTs may have resulted in a slight reduction of alcohol use. However, patients receiving SSRIs also likely had an increased risk of experiencing an adverse event. In addition, these conclusions only apply to postintervention and are not against active comparators, limiting the understanding of the efficacy of interventions in the long term as well as the comparative effectiveness of active treatments. As we did not have high confidence in any outcomes, additional studies are warranted to provide more conclusive evidence.
Competing Interests: We have read the journal’s policy and the authors of this manuscript have the following competing interests: SG’s spouse is a salaried-employee of Eli Lilly and Company, and owns stock. SG has accompanied his spouse on company-sponsored travel. All other authors have declared that no competing interests exist.
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تواريخ الأحداث: Date Created: 20211008 Date Completed: 20211214 Latest Revision: 20211214
رمز التحديث: 20231215
مُعرف محوري في PubMed: PMC8535380
DOI: 10.1371/journal.pmed.1003822
PMID: 34624018
قاعدة البيانات: MEDLINE
الوصف
تدمد:1549-1676
DOI:10.1371/journal.pmed.1003822