Clifford Gary M, Farmer Richard D T
Department of Pharmacoepidemiology and Public Health, Postgraduate Medical School, University of Surrey, Guildford, UK.
Pharmacoepidemiol Drug Saf. 2002 Jan-Feb;11(1):55-61. doi: 10.1002/pds.671.
Regulatory authorities have raised concern that alpha 1-blockers, prescribed predominantly for benign prostatic hyperplasia (BPH), may be associated with an increased risk of depression. The aim was to assess the risk of depression with alpha 1-blockers independently of that associated with symptoms being treated and concurrent illness.
Using a study population registered on the UK General Practice Research Database, and taking a prescription for an antidepressant as a proxy for clinical depression, we performed: (a) cohort analyses comparing the incidence of depression in current users of alpha 1-blockers versus non-users, and in men with BPH versus those without. (b) A nested case-control analysis looking at the association between depression and alpha 1-blocker exposure, accounting for the presence of BPH and other illness.
In the cohort analyses, risk of depression was significantly higher in men with BPH compared to those without (IRR 2.17, 2.12-2.22), but was not significantly different for men exposed to alpha 1-blockers versus those unexposed when adjusted for the presence of BPH. Cases of depression were more likely to have pre-existing BPH (crude OR 2.09, 2.02-2.15) than controls. After adjusting for concurrent illness (using number of GP visits as a proxy) and the presence of BPH (adjusted OR 1.38, 1.33-1.43), there was no association with depression for exposure to any alpha 1-blocker (adjusted OR 1.03, 0.90-1.18).
This study did not suggest that the prescribing of alpha 1-blockers increases the risk of being depressed. The association highlighted by spontaneous reporting systems appears to be explained by confounding by concurrent disease.
监管机构已对主要用于治疗良性前列腺增生（BPH）的α1受体阻滞剂可能增加抑郁症风险表示关注。本研究旨在独立于与所治疗症状及合并疾病相关的风险，评估使用α1受体阻滞剂引发抑郁症的风险。
利用英国全科医疗研究数据库中登记的研究人群，以开具抗抑郁药处方作为临床抑郁症的替代指标，我们进行了：（a）队列分析，比较当前使用α1受体阻滞剂者与未使用者、患有BPH的男性与未患BPH的男性中抑郁症的发病率。（b）一项巢式病例对照分析，研究抑郁症与α1受体阻滞剂暴露之间的关联，并考虑BPH及其他疾病的存在情况。
在队列分析中，患有BPH的男性患抑郁症的风险显著高于未患BPH的男性（发病率比值比[IRR]为2.17，范围2.12 - 2.22），但在调整BPH存在情况后，使用α受体阻滞剂的男性与未使用者之间的差异无统计学意义。与对照组相比，抑郁症患者更可能已有BPH（粗比值比[OR]为2.09，范围2.02 - 2.15）。在调整合并疾病（以全科医生就诊次数作为替代指标）及BPH的存在情况后（调整后OR为1.38，范围1.33 - 1.43），暴露于任何α1受体阻滞剂与抑郁症均无关联（调整后OR为1.03，范围0.90 - 1.18）。
本研究未表明开具α1受体阻滞剂会增加患抑郁症的风险。自发报告系统所强调的关联似乎可由合并疾病的混杂作用来解释。
