Predictors of Spontaneous and Systematically Assessed Suicidal Adverse Events in the Treatment of SSRI-Resistant Depression in Adolescents (TORDIA) Study
Predictors of Spontaneous and Systematically Assessed Suicidal Adverse Events in the Treatment of SSRI-Resistant Depression in Adolescents (TORDIA) Study
复制标题
DOI：
10.1176/appi.ajp.2008.08070976
复制
发表时间：
2009-04-01
影响因子：
17.7
通讯作者：
Keller, Martin B.
中科院分区：
文献类型：
--
作者：
Brent, David A.;Emslie, Graham J.;Keller, Martin B.
目的：作者试图在治疗的前 12 周内确定难治性抑郁青少年自残不良事件的预测因子。方法：对先前使用 SSRI 抗抑郁药进行的试验没有反应的抑郁青少年 (N=334) 被随机转为另一种 SSRI 或文拉法辛，接受或不接受认知行为治疗。自残事件，即自杀性和非自杀性自伤不良事件，通过前 181 名参与者的自发报告和最后 153 名参与者的每周系统评估进行评估。结果：自杀性（20.8% vs. 8.8%）和非自杀性自伤（17.6% vs. 2.2%）的发生率较高，但严重不良事件（8.4% vs. 2.2%）的发生率较高。 7.3%）是通过系统监测发现的。根据高基线自杀意念、家庭冲突以及吸毒和酗酒预测，发生自杀事件的中位时间为 3 周。根据既往非自杀性自残史预测，发生非自杀性自残的中位时间为 2 周。虽然治疗没有主要作用，但文拉法辛治疗与自杀意念较高的患者自残不良事件发生率较高相关。在少数参与者（N = 10）中，辅助使用苯二氮卓类药物与自杀性和非自杀性自残不良事件的发生率较高有关。结论：由于自杀性不良事件的预测因子也预测对治疗的反应不佳，并且其中许多事件发生在治疗早期，因此通过针对家庭冲突、自杀意念和药物使用来提高对抑郁症的反应速度可能有助于减少自杀性不良事件的发生率。 发生率。文拉法辛和苯二氮卓类药物与自残事件的关系需要进一步研究和临床谨慎。
Objective: The authors sought to identify predictors of self-harm adverse events in treatment-resistant, depressed adolescents during the first 12 weeks of treatment.Method: Depressed adolescents (N=334) who had not responded to a previous trial with an SSRI antidepressant were randomized to a switch to either another SSRI or venlafaxine, with or without cognitive behavior therapy. Self-harm events, i.e., suicidal and non-suicidal self-injury adverse events were assessed by spontaneous report for the first 181 participants, and by systematic weekly assessment for the last 153 participants.Results: Higher rates of suicidal (20.8% vs. 8.8%) and nonsuicidal self-injury (17.6% vs. 2.2%), but not serious adverse events (8.4% vs. 7.3%) were detected with systematic monitoring. Median time to a suicidal event was 3 weeks, predicted by high baseline suicidal ideation, family conflict, and drug and alcohol use. Median time to nonsuicidal self-injury was 2 weeks, predicted by previous history of nonsuicidal self-injury. While there were no main effects of treatment, venlafaxine treatment was associated with a higher rate of self-harm adverse events in those with higher suicidal ideation. Adjunctive use of benzodiazepines, while in a small number of participants (N=10) was associated with higher rate of both suicidal and nonsuicidal self-injury adverse events.Conclusions: Since predictors of suicidal adverse events also predict poor response to treatment, and many of these events occurred early in treatment, improving the speed of response to depression, by targeting of family conflict, suicidal ideation, and drug use may help to reduce their incidence. The relationship of venlafaxine and of benzodiazepines to self-harm events requires further study and clinical caution.