Finding factors that predict treatment-resistant depression: Results of a cohort study.
Finding factors that predict treatment-resistant depression: Results of a cohort study.
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DOI：
10.1002/da.22774
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发表时间：
2018-07
影响因子：
7.4
通讯作者：
Ryan P
中科院分区：
文献类型：
--
作者：
Cepeda MS;Reps J;Ryan P
抑郁症的治疗通常需要后续干预。对抗抑郁药没有反应的患者患有难治性抑郁症（TRD）。预测谁将患上 TRD 可能有助于医疗保健提供者做出更有效的治疗决策。我们试图使用索赔数据库来确定在现实环境中预测 TRD 的因素。在美国索赔数据库中进行了一项回顾性队列研究，对象是新诊断和治疗的抑郁症成人受试者，但没有躁狂、痴呆和精神病。索引日期是抗抑郁药配药的日期。结果为 TRD，定义为在索引日期后 1 年内至少服用三种不同的抗抑郁药或一种抗抑郁药和一种抗精神病药。预测因素包括索引日期前 1 年的年龄、性别、医疗状况、药物和手术。在 230,801 名患者中，10.4% 在 1 年内出现 TRD。基线时 TRD 患者更年轻； 10.87% 的人年龄在 18 至 19 岁之间，而无 TRD 组的这一比例为 7.64%，风险比 (RR) = 1.42（95% 置信区间 [CI] 1.37-1.48）。 TRD 患者在基线时比非 TRD 患者更有可能患有焦虑症，RR = 1.38（95% CI 1.35-1.14）。疲劳的 RR 为 3.68（95% CI 3.18-4.25）。 TRD 患者在基线时比非 TRD 患者更常见物质使用障碍、精神疾病、失眠和疼痛。新诊断并接受抑郁症治疗的受试者中有 10% 在一年内出现 TRD。与非 TRD 患者相比，他们更年轻，更容易遭受疲劳、药物滥用障碍、焦虑、精神疾病、失眠和疼痛的困扰。
Treatment for depressive disorders often requires subsequent interventions. Patients who do not respond to antidepressants have treatment‐resistant depression (TRD). Predicting who will develop TRD may help healthcare providers make more effective treatment decisions. We sought to identify factors that predict TRD in a real‐world setting using claims databases. A retrospective cohort study was conducted in a US claims database of adult subjects with newly diagnosed and treated depression with no mania, dementia, and psychosis. The index date was the date of antidepressant dispensing. The outcome was TRD, defined as having at least three distinct antidepressants or one antidepressant and one antipsychotic within 1 year after the index date. Predictors were age, gender, medical conditions, medications, and procedures 1 year before the index date. Of 230,801 included patients, 10.4% developed TRD within 1 year. TRD patients at baseline were younger; 10.87% were between 18 and 19 years old versus 7.64% in the no‐TRD group, risk ratio (RR) = 1.42 (95% confidence interval [CI] 1.37–1.48). TRD patients were more likely to have an anxiety disorder at baseline than non‐TRD patients, RR = 1.38 (95% CI 1.35–1.14). At 3.68, fatigue had the highest RR (95% CI 3.18–4.25). TRD patients had substance use disorders, psychiatric conditions, insomnia, and pain more often at baseline than non‐TRD patients. Ten percent of subjects newly diagnosed and treated for depression developed TRD within a year. They were younger and suffered more frequently from fatigue, substance use disorders, anxiety, psychiatric conditions, insomnia, and pain than non‐TRD patients.
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影响因子：
39.2
作者：
Stang, Paul E.;Ryan, Patrick B.;Woodcock, Janet
通讯作者：
Woodcock, Janet
影响因子：
6
作者：
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通讯作者：
Nierenberg, Andrew A.
影响因子：
6.9
作者：
Addington, AM;Gallo, JJ;Eaton, WW
通讯作者：
Eaton, WW
影响因子：
4.3
作者：
Cepeda, M. Soledad;Stang, Paul;Wittenberg, Gayle M.
通讯作者：
Wittenberg, Gayle M.
影响因子：
5.3
作者：
Kautzky, Alexander;Baldinger-Melich, Pia;Kasper, Siegfried
通讯作者：
Kasper, Siegfried