Efficacy, acceptability, and tolerability of antidepressants for sleep quality disturbances in post-traumatic stress disorder: A systematic review and network meta-analysis

Costa, Gabriela de Moraes; Ziegelmann, Patrícia Klarmann; Zanatta, Fabrício Batistin; Martins, Carolina Castro; Costa, Patrícia de Moraes; Mello, Carlos Fernando

doi:10.1016/j.pnpbp.2022.110557

Cited by 8 publications

(9 citation statements)

References 39 publications

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“…First, some studies we included may have enrolled patients with IBD who had previously used antidepressants or who had other psychiatric conditions. Considering that antidepressants have a significant time-course relationship 57 and can also improve symptoms of other psychiatric disorders, 58 – 60 our findings may be exaggerated. Second, most of the studies were conducted in Asia, which means that our results may not be generalizable to all IBD populations.…”

Section: Discussionmentioning

confidence: 74%

Effect of antidepressants on psychological comorbidities, disease activity, and quality of life in inflammatory bowel disease: a systematic review and meta-analysis

Wang

Liang

Chen

et al. 2023

Therap Adv Gastroenterol

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Background: Patients with inflammatory bowel disease (IBD) are often accompanied by a more significant burden of depression or anxiety, and approximately one-third are prescribed antidepressants. However, previous studies on the efficacy of antidepressants in IBD have shown inconsistent results. Objectives: To evaluate the effect of antidepressants on depression, anxiety, disease activity, and quality of life (QoL) in IBD patients. Design: A systematic review and meta-analysis. Methods: We searched MEDLINE via Ovid, EMBASE via Ovid, the Cochrane Library, CINAHL, PsycINFO, Chinese CBM Database, China National Knowledge Infrastructure, VIP, and Wanfang Database from inception to 13th July 2022 without language restrictions. Results: In all, 13 studies containing 884 individuals were included. Compared with the control group, antidepressants were superior in reducing depression scores [standardized mean difference (SMD) = −0.791; 95% confidence interval (CI): −1.009 to −0.572; p < 0.001], anxiety scores (SMD = −0.877; 95% CI: −1.203 to −0.552; p < 0.001), and disease activity scores (SMD = −0.323; 95% CI: −0.500 to −0.145; p < 0.001). Antidepressants had a positive effect in reaching clinical remission [risk ratio (RR) = 1.383; 95% CI: 1.176–1.626; p < 0.001]. Higher physical QoL (SMD = 0.578; 95% CI: 0.025–1.130; p = 0.040), social QoL (SMD = 0.626; 95% CI: 0.073–1.180; p = 0.027), and Inflammatory Bowel Disease Questionnaire (SMD = 1.111; 95% CI: 0.710–1.512; p < 0.001) were found in the experimental group. No significant differences were observed in clinical response (RR = 1.014; 95% CI: 0.847–1.214; p = 0.881), psychological QoL (SMD = 0.399; 95% CI: −0.147 to 0.944; p = 0.152), and environmental QoL (SMD = 0.211; 95% CI: −0.331 to 0.753; p = 0.446). Conclusion: Antidepressants are effective for ameliorating depression, anxiety, disease activity, and QoL in IBD patients. Due to most studies having a small sample size, further well-designed studies are required.

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Section: Discussionmentioning

confidence: 74%

Effect of antidepressants on psychological comorbidities, disease activity, and quality of life in inflammatory bowel disease: a systematic review and meta-analysis

Wang

Liang

Chen

et al. 2023

Therap Adv Gastroenterol

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“…In a recent meta-analysis examining effects of antidepressants on sleep quality among patients with PTSD [ 86 ], paroxetine was not found to be efficacious in improving sleep quality and reducing sleep disturbances, with similar acceptability to other antidepressants (sertraline and mirtazapine) and placebo. However, it is worth mentioning that only one small, unpublished clinical trial was included in the meta-analysis [ 87 ], which was terminated due to recruitment difficulties.…”

Section: Selective Serotonin Reuptake Inhibitors (Ssris)mentioning

confidence: 99%

“…In a recent network meta-analysis examining the effects of antidepressants on sleep quality among patients with PTSD [ 86 ], sertraline was the only antidepressant that was found possibly efficacious in reducing sleep disturbances, but not in improving sleep quality, with similar acceptability to other antidepressants (mirtazapine and paroxetine) and placebo. However, it is worth mentioning that the certainty of evidence is low, as a relatively small number of patients were included in the meta-analysis of 4 RCTs [ 33 , 37 , 95 , 97 ].…”

Section: Selective Serotonin Reuptake Inhibitors (Ssris)mentioning

confidence: 99%

Effects of Antidepressants on Sleep in Post-traumatic Stress Disorder: An Overview of Reviews

Lappas

Polyzopoulou

Christodoulou

et al. 2024

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Antidepressants are a commonly used, easily accessible, and overall safe treatment option for post-traumatic stress disorder (PTSD). The present review aims to evaluate the efficacy and safety of antidepressants in treating sleep disturbances in patients with PTSD. PubMed and the Cochrane Li- brary were searched (July 2022) for systematic reviews and meta-analyses on the treatment of PTSD. Moreover, PubMed and ClinicalTrials.gov were searched for individual trials investigating the antidepressant treatment of PTSD (up to September 2022), and reference lists of all relevant identi- fied studies were screened. Sleep-related outcomes, i.e., total sleep time, sleep quality, dreams/ nightmares, insomnia, and somnolence, were extracted independently by at least two reviewers. Meta- analytic evaluations were performed wherever possible. 39 randomised controlled trials (RCTs) were identified; data from pooled analyses, reviews, and observational studies were used for antidepressants with a weak evidence base or when their findings were deemed important. Overall, scarce data exist on the effects of antidepressants on sleep outcomes among patients with PTSD. Some evidence may support the use of amitriptyline, nefazodone, paroxetine, and sertraline for improving sleep in patients with PTSD. Τhere was a meta-analytical trend indicating improvement of nightmares with fluoxetine, less insomnia with amitriptyline and more with brofaromine, as well as more somnolence with paroxe- tine vs. placebo, respectively. However, data from more than 1 RCT with a considerable number of pa- tients were only available for paroxetine. Evidence is insufficient to draw safe conclusions. More and better-designed RCTs, with consistent reporting of sleep-related outcomes, are needed.

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“…Psychological trauma may affect the individual’s response to antidepressants, clinical outcomes, and function. Regarding the treatment of PTSD, paroxetine, sertraline, fluoxetine, and venlafaxine are recommended, however, the efficiency of selective serotonin reuptake inhibitors (SSRIs) or serotonin and noradrenaline reuptake inhibitors in PTSD is comparably low (only about half as strong)[ 44 ]. Psychotherapy is the treatment of choice for PTSD, including cognitive behavior therapy (CBT), prolonged exposure, and eye movement desensitization and reprocessing (EMDR)[ 45 ].…”

Section: Ptsd and Trauma-related Depressionmentioning

confidence: 99%

Psychological trauma, posttraumatic stress disorder and trauma-related depression: A mini-review

Wang¹,

Feng²,

Yu³

et al. 2023

World J Psychiatry

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There are various types of traumatic stimuli, such as catastrophic events like wars, natural calamities like earthquakes, and personal trauma from physical and psychological neglect or abuse and sexual abuse. Traumatic events can be divided into type I and type II trauma, and their impacts on individuals depend not only on the severity and duration of the traumas but also on individuals’ self-evaluation of the traumatic events. Individual stress reactions to trauma include posttraumatic stress disorder (PTSD), complex PTSD and trauma-related depression. Trauma-related depression is a reactive depression with unclear pathology, and depression occurring due to trauma in the childhood has gained increasing attention, because it has persisted for a long time and does not respond to conventional antidepressants but shows good or partial response to psychotherapy, which is similar to the pattern observed for PTSD. Because trauma-related depression is associated with high risk of suicide and is chronic with a propensity to relapse, it is necessary to explore its pathogenesis and therapeutic strategy.

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Efficacy, acceptability, and tolerability of antidepressants for sleep quality disturbances in post-traumatic stress disorder: A systematic review and network meta-analysis

Cited by 8 publications

References 39 publications

Effect of antidepressants on psychological comorbidities, disease activity, and quality of life in inflammatory bowel disease: a systematic review and meta-analysis

Effect of antidepressants on psychological comorbidities, disease activity, and quality of life in inflammatory bowel disease: a systematic review and meta-analysis

Effects of Antidepressants on Sleep in Post-traumatic Stress Disorder: An Overview of Reviews

Psychological trauma, posttraumatic stress disorder and trauma-related depression: A mini-review

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