Simultaneous Antidepressant and Benzodiazepine New Use and Subsequent Long-term Benzodiazepine Use in Adults With Depression, United States, 2001-2014
Simultaneous Antidepressant and Benzodiazepine New Use and Subsequent Long-term Benzodiazepine Use in Adults With Depression, United States, 2001-2014
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DOI：
10.1001/jamapsychiatry.2017.1273
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发表时间：
2017-07-01
期刊：
影响因子：
25.8
通讯作者：
Miller, Matthew
中科院分区：
文献类型：
--
作者：
Bushnell, Greta A.;Sturmer, Til;Miller, Matthew
对于正在开始抗抑郁治疗的抑郁症患者来说，苯二氮卓类药物的重要性是短期的，以更快地改善抑郁症状，缓解伴随的焦虑，并提高抗抑郁药治疗的连续性。然而，苯二氮类药物治疗与风险相关，包括依赖性，这可能只需要几周的时间。目的研究在开始服用抗抑郁药的抑郁症患者中，苯二氮卓类药物和抗抑郁药同时使用的趋势，通过同时使用抗抑郁药的情况评估抗抑郁药的治疗时间，估计同时使用抗抑郁药和苯二氮卓类药物的人随后的长期使用，并确定同时新用和长期使用苯二氮卓类药物的决定因素。设计、设置和参与者使用美国商业索赔数据库进行的这项队列研究包括从2001年1月1日至2014年12月31日的商业保险成年人(18-岁)最近诊断为抑郁症的患者开始抗抑郁治疗，但在前一年没有使用抗抑郁药或苯二氮卓类药物。研究同时新用药，定义为与新抗抑郁药处方在同一天分发的新苯二氮类药物处方。主要结果和测量抗抑郁药启动剂与同时新用药和持续抗抑郁药治疗6个月的比例，以及同时接受长期(6个月)苯二氮卓类药物治疗的新使用者的比例。结果对765 130名成年人(中位年龄，39岁；四分位数范围29-49岁；507451名女性(66.3%)开始抗抑郁治疗，81020名(10.6%)也开始苯二氮类药物治疗。从2001年到2014年，两种药物同时开始使用的比例平均每年增长0.49%(95%可信区间，0.47%-0.51%)，从2001年的6.1%(95%可信区间，5.5%-6.6%)上升到2012年的12.5%(95%可信区间，12.3%-12.7%)，并在2014年保持稳定(11.3%；95%可信区间，11.1%-11.5%)。类似的发现在年龄组和医生类型中也很明显。在同时使用新药物和不同时使用新药物的患者中，抗抑郁药物的治疗时间相似。在同时使用苯二氮卓类药物的新使用者中，12.3%(95%可信区间，12.0%-12.5%)曾长期服用苯二氮卓类药物(64.0%的患者在首次服药后停止服用苯二氮卓类药物)。同时新用药后长期使用苯二氮卓类药物的决定因素是较长的初始苯二氮卓类药物供应天数、长效苯二氮卓类药物的首次处方和最近处方的阿片类药物填充物。结论和相关十分之一的抗抑郁药启动剂同时开始苯二氮卓类药物治疗。同时新用药情况下，6个月时抗抑郁药治疗情况差异无统计学意义。由于与苯二氮卓类药物相关的风险，在抗抑郁药开始时同时使用新的药物和苯二氮卓类药物方案本身需要仔细考虑。
IMPORTANCE Benzodiazepines have been prescribed for short periods to patients with depression who are beginning antidepressant therapy to improve depressive symptoms more quickly, mitigate concomitant anxiety, and improve antidepressant treatment continuation. However, benzodiazepine therapy is associated with risks, including dependency, which may take only a few weeks to develop.OBJECTIVES To examine trends in simultaneous benzodiazepine and antidepressant new use among adults with depression initiating an antidepressant, assess antidepressant treatment length by simultaneous new use status, estimate subsequent long-term benzodiazepine use in those with simultaneous antidepressant and benzodiazepine new use, and identify determinants of simultaneous new use and long-term benzodiazepine use.DESIGN, SETTING, AND PARTICIPANTS This cohort study using a US commercial claims database included commercially insured adults (aged 18-64 years) from January 1, 2001, through December 31, 2014, with a recent depression diagnosis who began antidepressant therapy but had not used antidepressants or benzodiazepines in the prior year.EXPOSURES Simultaneous new use, defined as a new benzodiazepine prescription dispensed on the same day as a new antidepressant prescription.MAIN OUTCOMES AND MEASURES The proportion of antidepressant initiators with simultaneous new use and continuing antidepressant treatment for 6 months and the proportion of simultaneous new users receiving long-term (6-months) benzodiazepine therapy.RESULTS Of the 765 130 adults (median age, 39 years; interquartile range, 29-49 years; 507 451 women [66.3%]) who initiated antidepressant treatment, 81 020 (10.6%) also initiated benzodiazepine treatment. The mean annual increase in the proportion simultaneously starting use of both agents from 2001 to 2014 was 0.49% (95% CI, 0.47%-0.51%), increasing from 6.1% (95% CI, 5.5%-6.6%) in 2001 to 12.5%(95% CI, 12.3%-12.7%) in 2012 and stabilizing through 2014 (11.3%; 95% CI, 11.1%-11.5%). Similar findings were apparent by age group and physician type. Antidepressant treatment length was similar in simultaneous new users and non-simultaneous new users. Among simultaneous new users, 12.3%(95% CI, 12.0%-12.5%) exhibited long-term benzodiazepine use (64.0% discontinued taking benzodiazepines after the initial fill). Determinants of long-term benzodiazepine use after simultaneous new use were longer initial benzodiazepine days' supply, first prescription for a long-acting benzodiazepine, and recent prescription opioid fills.CONCLUSIONS AND RELEVANCE One-tenth of antidepressant initiators with depression simultaneously initiated benzodiazepine therapy. No meaningful difference in antidepressant treatment at 6 months was observed by simultaneous new use status. Because of the risks associated with benzodiazepines, simultaneous new use at antidepressant initiation and the benzodiazepine regimen itself require careful consideration.