Use of benzodiazepines and selective serotonin reuptake inhibitors in middle-aged and older adults with anxiety disorders -: A longitudinal and prospective study
Use of benzodiazepines and selective serotonin reuptake inhibitors in middle-aged and older adults with anxiety disorders -: A longitudinal and prospective study
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DOI：
10.1097/jgp.0b013e31815aff5c
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发表时间：
2008-01-01
影响因子：
7.2
通讯作者：
Keller, Martin B.
中科院分区：
文献类型：
--
作者：
Benitez, Carlos Israel Perez;Smith, Kevin;Keller, Martin B.
目的：本研究的目的是在九年的随访中检查苯二氮卓类药物（BZ）和选择性血清素再摄取抑制剂/选择性去甲肾上腺素再摄取抑制剂（SSRIs/SNRIs）在诊断为惊恐障碍（伴或不伴广场恐惧症、社交恐惧症或广泛性焦虑症）的中老年人中的使用情况。背景和参与者：本研究的参与者参加了哈佛/布朗焦虑研究项目（HARP）。 HARP 是一项自然主义、纵向、多地点研究，对象是从精神病机构招募的患有焦虑症的成年人。分析样本由 51 名基线年龄为 55 至 70 岁的焦虑症参与者组成，并添加了 211 名年轻参与者进行比较分析。设计：作者通过使用广义估计方程模型评估服用药物的参与者比例，研究了患有焦虑症的参与者随年龄增长的药物使用模式（BZ 和 SSRIs/SNRIs）。测量：目前的数据来源于入组时进行的结构化诊断访谈，结合了精神疾病诊断和统计手册的结构化临床访谈、第三版-R非情感性障碍、患者版本、情感性障碍的研究诊断标准时间表-终生，以及使用纵向间隔随访评估-法玛西亚和普强的后续随访访谈，以评估每周的疾病病程，以表明综合征的严重程度和情况。每周按特定类型和剂量记录药物使用情况。结果：研究结果显示，在控制焦虑症发作时间后，老年组（基线时为 53%）和年轻组（57.4%）的 BZ 使用率都很高，并且没有随着时间的推移而显着下降。随着时间的推移，两组中 SSRI/SNRI 的使用都有统计学上的显着增加。研究开始时，18% 的老年组和 21% 的年轻组正在使用 SSRIs/SNRls；然而，在研究结束时，这一比例分别增加到 35% 和 43%。 结论：尽管在研究过程中患有焦虑症的老年参与者中 SSRI/SNRI 的使用有所增加，但在 9 年的随访中，只有 35% 的参与者使用 SSRI/SNRI 药物，而超过一半的参与者继续使用 BZ。据作者所知，尚无随机临床试验能够比较 BZ 和 SSRI/SNRI 在此人群中的疗效和安全性。然而，有记录的证据表明长期使用 BZ 会产生不利影响以及老年人群产生依赖性的风险。
Objective: The purpose of this study was to examine the use of benzodiazepines (BZs) and selective serotonin reuptake inbibitors/selective norepinepbrine reuptake inhibitors (SSRIs/SNRIs) over nine years of follow-up in middle-aged and older adults with diagnoses of panic disorder with or without agoraphobia, social phobia, or generalized anxiety disorder. Setting and Participants: Participants in this study were enrolled in the Harvard/Brown Anxiety Research Project (HARP). HARP is a naturalistic, longitudinal, multisite study of adults with anxiety disorders who are recruited from psychiatric settings. The analytic sample consisted of 51 participants with anxiety disorders who were 55 to 70 years old at baseline and a younger cobort of 211 participants added for comparative analysis. Design: The authors examined patterns of medication use (BZs and SSRIs/SNRIs) in participants with anxiety disorders as the aged, by assessing the proportion of participants taking they medications using generalized estimating equation modeling. Measurements: The present data were derived from the structured diagnostic interview administered at enrollment using a combination of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Third Edition-R Non-Affective Disorder, Patient Version, Research Diagnostic Criteria Schedule for Affective Disorders-Lifetime, and subsequent follow-up interviews over a nine-year period using the Longitudinal Interval Follow-up Evaluation-Pharmacia & Upjohn to assess the weekly course of disorders to indicate syndrome severity and document medication use by specific type and dose on a weekly basis. Results: Findings showed that rates of BZ use were high among both the older (53% at baseline) and the younger (57.4%) age groups and did not significantly decrease over time, after controlling for time in episode of their anxiety disorders. There was a statistically significant increase in SSRI/SNRI use over time in both groups. At the beginning of the study, 18% of the older group and 21% of the younger group were using SSRIs/SNRls; however, at the end of the study, the rates increased to 35% and 43%, respectively, Conclusions: Although there was an increase in SSRI/SNRI use in older participants with anxiety disorders over the course of study, at nine years of follow-up, only 35% of participants were utilizing SSRI/SNRI medication, while more than one-half` of the same participants were continuing to use BZs. To the autbors' knowledge, there are no randomized clinical trials that have addressed comparative efficacy and safety of BZs and SSRIs/SNRIs in this population. However, there is documented evidence of adverse effects of chronic BZ use and the risk of developing dependency in older populations.