GUO Liping 1,2 , ZHANG Guohua 3 , LI Meixuan 1,2 , KONG Weize 1,2 , WU Yanan 1,2 , WEI Zhipeng 1,2 , YANG Kehu 1,2
  • 1. Evidence-based Medicine Center, School of Basic Medicine Sciences, Lanzhou University, Lanzhou 730000, P. R. China;
  • 2. Center for Evidence-based Social Science, Lanzhou University, Lanzhou 730000, P. R. China;
  • 3. First School of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou 730000, P. R. China;
WEI Zhipeng, Email: weizhp20@lzu.edu.cn; YANG Kehu, Email: yangkh@lzu.edu.cn
Major depressive disorder; Selective serotonin reuptake inhibitors; Escitalopram inflammatory; Control study; Meta-analysis; xxxx
10.7507/1672-2531.2025008006
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Objective To systematically review the antidepressant efficacy of selective serotonin re-uptake inhibitors (SSRIs) and their effect on inflammatory factors in adults with major depressive disorder (MDD). Methods Electronic searches were conducted in PubMed, Embase, Web of Science Core Collection, ProQuest, JSTOR, PsycINFO, The Cochrane Library, Epistemonikos, China National Knowledge Infrastructure (CNKI), and Chinese Biomedical Literature Database (CBM) from database inception to December 31, 2024. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Meta-analysis was performed using R 4.4.2 software. Results A total of 62 controlled studies (including 63 reports) was included, consisting of 36 randomized controlled trials (RCTs), 4 non-randomized controlled trials (NRCTs), and 23 case-control studies. Meta-analysis showed that the overall antidepressant effect size of SSRIs was SMD ?3.18, 95%CI ?3.56 to ?2.80, with no statistically significant difference in efficacy between different SSRIs (Q=6.77, P=0.24). However, their antidepressant efficacy was influenced by the country of origin of the study participants and the duration of intervention. SSRIs exerted significant inhibitory effects on 17 pro-inflammatory factors, but with high heterogeneity. SSRIs had no significant overall effect on anti-inflammatory factors (SMD 0.81, 95%CI ?0.20 to 1.82). However, subgroup analysis revealed that escitalopram exerted significant promoting effects on IL-10 (SMD 1.11, 95%CI 0.61 to1.60) and IL-13 (SMD 2.40, 95%CI 1.84 to 2.95). Conclusion SSRIs are effective antidepressants but vary in their effects on inflammatory factors. Among them, escitalopram has a potential bidirectional regulatory effect on inflammatory factors, and more high-quality multicenter studies are needed in the future for verification..

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