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JAMA Psychiatry:成年抑郁症患者同时使用抗抑郁药和苯二氮䓬类需仔细考量

2017-08-01 选题审校:安雅晶 编辑:吴星 环球医学

2017年7月,发表在《JAMA Psychiatry》的一项由美国科学家进行的研究考察了2001~2014年,美国成年抑郁症患者同时使用抗抑郁药和苯二氮䓬类新使用及后续苯二氮?类长期使用的情况。

2017年7月,发表在《JAMA Psychiatry》的一项由美国科学家进行的研究考察了2001~2014年,美国成年抑郁症患者同时使用抗抑郁药和苯二氮䓬类新使用及后续苯二氮?类长期使用的情况。

重要性:为开始抗抑郁药治疗的抑郁症患者处方短期苯二氮䓬类,可更快地改善抑郁症状,减轻并发的焦虑,并改善抗抑郁药治疗的延续性。但是,苯二氮?类与风险相关,包括依赖性,可能仅需要几周就能形成。

目的:考察开始使用抗抑郁药的抑郁症患者中,同时使用苯二氮䓬类和抗抑郁药新使用的趋势,评估同时新使用状态下抗抑郁药治疗的时间,评估同时抗抑郁药和苯二氮?类新使用的患者中,后续苯二氮䓬类长期使用情况,并确定同时新使用和长期苯二氮䓬使用的决定因素。

设计、地点和参与者:该队列研究使用美国商业保险赔付数据库,纳入2001年1月1日至2014年12月31日参加商业保险的成人(年龄18~64岁),近期确诊为抑郁症并开始抗抑郁药治疗,但在前1年未使用过抗抑郁药或苯二氮䓬类。

暴露:同时新用,定义为同一天开始分配新苯二氮䓬类和新抗抑郁药处方。

主要结局和测量:初始抗抑郁药患者和同事新用及继续抗抑郁药治疗合用两6个月的患者比例,和接受长期(6个月)苯二氮䓬类治疗的同时新用患者比例。

结果:在765130例(中位年龄,39岁;四分位间距,29~49岁;507451例女性[66.3%])初始抗抑郁药治疗的成人中,81020例(10.6%)也初始苯二氮?类治疗。从2001年至2014年,同时开始使用两种药物的平均年增长率为0.49%(95% CI,0.47%~0.51%),从2001年的6.1%(95% CI,5.5%~6.6%)增加至2012年的12.5%(95% CI,12.3%~12.7%),直到2014年维持稳定(11.3%;95% CI,11.1%~11.5%)。不同年龄组和医生类型的结果相似。同时新使用者和非同时新使用者中抗抑郁药治疗时间相似。同时新使用者中,12.3%(95% CI,12.0%~12.5%)表现为苯二氮䓬类长期使用(64.0%在初始治疗完成后停用苯二氮?类)。同时新使用后,长期使用苯二氮䓬类的决定因素为初始苯二氮䓬类供应天数长,首个处方为长效苯二氮类和最近处方阿片类药物。

结论和相关性:1/10的初始抗抑郁药的患者同时初始苯二氮䓬类治疗。根据同时新使用状态,未观察到6个月时抗抑郁药治疗的显着差异。由于与苯二氮䓬类相关的风险,在抗抑郁药初始治疗时同时新使用苯二氮䓬类,以及苯二氮䓬类方案本身均需要仔细考虑。

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