Dunn R L, Donoghue J M, Ozminkowski R J, Stephenson D, Hylan T R
University of Michigan, Ann Arbor, USA.
J Psychopharmacol. 1999;13(2):136-43. doi: 10.1177/026988119901300204.
The objective of this study was to determine whether patients beginning therapy on the most common tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) differed in their likelihood of having antidepressant treatment that was consistent with recommended treatment guidelines in the UK. An analytical file constructed from a large general practitioner medical records database (DIN-LINK) from the UK for the years 1992-97 was constructed. A total of 16,204 patients with a new episode of antidepressant therapy who initiated therapy on one of the most often prescribed TCAs (amitriptyline, dothiepin, imipramine and lofepramine) or SSRIs (fluoxetine, paroxetine and sertraline) were analysed. A dichotomous measure was defined to indicate whether subjects were prescribed at least 120 days of antidepressant therapy at an adequate average daily dose within the first 6 months after initiation of therapy. Only 6.0% of patients initiating therapy on aTCA and 32.9% of patients initiating therapy on a SSRI were prescribed antidepressant treatment that was consistent with treatment guidelines. After controlling for observable characteristics, patients who initiated therapy on a SSRI were much more likely (odds ratio=7.473, p<0.001) to have a prescribed average daily dose and duration consistent with recommended treatment guidelines within the first 6 months of initiating therapy than were patients who initiated therapy on a TCA. These findings suggest that initial antidepressant selection is an important determinant of whether the subsequent course of treatment is consistent with current national guidelines for the treatment of depression in the UK.
本研究的目的是确定开始使用最常见的三环类抗抑郁药（TCA）和选择性5-羟色胺再摄取抑制剂（SSRI）进行治疗的患者，在接受符合英国推荐治疗指南的抗抑郁治疗的可能性方面是否存在差异。利用英国一个大型全科医生医疗记录数据库（DIN-LINK）构建了1992年至1997年的分析文件。共分析了16204例开始抗抑郁治疗新疗程的患者，这些患者开始使用最常处方的TCA（阿米替林、多塞平、丙咪嗪和洛非帕明）或SSRI（氟西汀、帕罗西汀和舍曲林）之一进行治疗。定义了一个二分法指标，以表明受试者在开始治疗后的前6个月内是否以足够的平均日剂量接受了至少120天的抗抑郁治疗。开始使用TCA治疗的患者中只有6.0%，开始使用SSRI治疗的患者中有32.9%接受了符合治疗指南的抗抑郁治疗。在对可观察特征进行控制后，开始使用SSRI治疗的患者在开始治疗后的前6个月内，比开始使用TCA治疗的患者更有可能（优势比=7.473，p<0.001）接受符合推荐治疗指南的规定平均日剂量和疗程。这些发现表明，初始抗抑郁药物的选择是后续治疗过程是否符合英国当前抑郁症治疗国家指南的一个重要决定因素。
