Mortality risk of antipsychotic augmentation for adult depression.
Mortality risk of antipsychotic augmentation for adult depression.
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DOI：
10.1371/journal.pone.0239206
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发表时间：
2020
期刊：
影响因子：
3.7
通讯作者：
Olfson M
中科院分区：
文献类型：
--
作者：
Gerhard T;Stroup TS;Correll CU;Setoguchi S;Strom BL;Huang C;Tan Z;Crystal S;Olfson M
随机对照试验表明，接受新型抗精神病药物治疗的老年痴呆症患者的全因死亡率有所增加。目前尚不清楚这种风险是否普遍适用于使用新型抗精神病药物作为抑郁症强化治疗的非老年人。这项研究调查了新型抗精神病药物增强治疗成人抑郁症的全因死亡风险。基于人群的新用户/活跃比较队列研究。 2001 年至 2010 年美国医疗补助计划的国家医疗保健索赔数据与国家死亡指数相关。被诊断患有抑郁症的非老年人（25-64 岁）在接受 ≥3 个月的抗抑郁单一治疗后开始使用新的抗精神病药物或第二种抗抑郁药物进行强化治疗。具有其他抗精神病药物适应症的患者，例如精神分裂症、精神病性抑郁症或双相情感障碍，被排除在外。使用新型抗精神病药物或第二种抗抑郁药物加强治疗抑郁症。根据国家死亡指数确定研究随访期间的全因死亡率。分析队列包括 39,582 名患者（女性 = 78.5%，平均年龄 = 44.5 岁），他们开始使用新型抗精神病药物（n = 22,410；40% = 喹硫平，21% = 利培酮，17% = 阿立哌唑，16% = 奥氮平）或第二种抗抑郁药（n = 17,172）。所有新型抗精神病药物的中位氯丙嗪当量起始剂量为 68 毫克/天，在随访期间增加至 100 毫克/天。总共有 153 名患者在 13,328 人年的随访期间死亡（新的抗精神病药物增强治疗：n = 105，随访 = 7,601 人年，死亡率 = 138.1/10,000 人年；抗抑郁药物增强治疗：n = 48，随访 = 5,727 人年，死亡率 = 83.8/10,000 人年）。调整后的风险比为 1.45（95% 置信区间，1.02 至 2.06），表明与抗抑郁药物增强治疗相比，新型抗精神病药物增强治疗的全因死亡风险增加（风险差异 = 37.7（95% CI，1.7 至 88.8）/10,000 人年）。多项敏感性分析的结果都很稳健。与添加第二种抗抑郁药相比，在非老年抑郁症患者中增加新型抗精神病药的剂量与死亡风险增加相关。尽管这些发现需要重复并且不能证明因果关系，但治疗成人抑郁症的医生应该意识到与新的抗精神病药物增强相关的死亡率增加的可能性。
Randomized controlled trials have demonstrated increased all-cause mortality in elderly patients with dementia treated with newer antipsychotics. It is unknown whether this risk generalizes to non-elderly adults using newer antipsychotics as augmentation treatment for depression. This study examined all-cause mortality risk of newer antipsychotic augmentation for adult depression. Population-based new-user/active comparator cohort study. National healthcare claims data from the US Medicaid program from 2001–2010 linked to the National Death Index. Non-elderly adults (25–64 years) diagnosed with depression who after ≥3 months of antidepressant monotherapy initiated either augmentation with a newer antipsychotic or with a second antidepressant. Patients with alternative indications for antipsychotic medications, such as schizophrenia, psychotic depression, or bipolar disorder, were excluded. Augmentation treatment for depression with a newer antipsychotic or with a second antidepressant. All-cause mortality during study follow-up ascertained from the National Death Index. The analytic cohort included 39,582 patients (female = 78.5%, mean age = 44.5 years) who initiated augmentation with a newer antipsychotic (n = 22,410; 40% = quetiapine, 21% = risperidone, 17% = aripiprazole, 16% = olanzapine) or with a second antidepressant (n = 17,172). The median chlorpromazine equivalent starting dose for all newer antipsychotics was 68mg/d, increasing to 100 mg/d during follow-up. Altogether, 153 patients died during 13,328 person-years of follow-up (newer antipsychotic augmentation: n = 105, follow-up = 7,601 person-years, mortality rate = 138.1/10,000 person-years; antidepressant augmentation: n = 48, follow-up = 5,727 person-years, mortality rate = 83.8/10,000 person-years). An adjusted hazard ratio of 1.45 (95% confidence interval, 1.02 to 2.06) indicated increased all-cause mortality risk for newer antipsychotic augmentation compared to antidepressant augmentation (risk difference = 37.7 (95%CI, 1.7 to 88.8) per 10,000 person-years). Results were robust across several sensitivity analyses. Augmentation with newer antipsychotics in non-elderly patients with depression was associated with increased mortality risk compared with adding a second antidepressant. Though these findings require replication and cannot prove causality, physicians managing adults with depression should be aware of this potential for increased mortality associated with newer antipsychotic augmentation.
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DOI：
10.1161/circoutcomes.113.000359
发表时间：
2013-09-01
期刊：
Circulation. Cardiovascular quality and outcomes
影响因子：
--
作者：
Brookhart MA;Wyss R;Layton JB;Stürmer T
通讯作者：
Stürmer T
影响因子：
6.7
作者：
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Schneeweiss, Sebastian
影响因子：
3.2
作者：
Philip NS;Carpenter LL;Tyrka AR;Price LH
通讯作者：
Price LH
DOI：
10.1136/bmj.e977
发表时间：
2012-02-23
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Huybrechts KF;Gerhard T;Crystal S;Olfson M;Avorn J;Levin R;Lucas JA;Schneeweiss S
通讯作者：
Schneeweiss S
影响因子：
10.6
作者：
Andreasen, Nancy C.;Pressler, Marcus;Nopoulos, Peg;Miller, Del;Ho, Beng-Choon
通讯作者：
Ho, Beng-Choon