Soudry Agnès, Dufouil Carole, Ritchie Karen, Dartigues Jean-François, Tzourio Christophe, Alpérovitch Annick
Institut National de la Santé et de la Recherche Médicale (INSERM-U708), Paris, France.
Int J Geriatr Psychiatry. 2008 Mar;23(3):324-30. doi: 10.1002/gps.1890.
The aim of this study was to identify factors associated with antidepressant use in non-depressed and depressed elderly persons, assuming that they varied according to clinical status.
We studied 7,868 French community-dwelling subjects aged 65 years and over. The Center for Epidemiological Studies-Depression scale and the Mini International Neuropsychiatric Interview were used to define three groups: non-depressed, high depressive symptoms and current major depressive disorder. Separate analyses were performed to identify the factors which were associated with antidepressant use in each group.
Antidepressant use (55% selective serotonin re-uptake inhibitors, 25% tricyclic antidepressants, 20% other types) increased from 4.9% in non-depressed subjects to 17.3% in subjects with high depressive symptoms (HDS) and 33.6% of in those with current major depressive disorder (MDD). The factors associated with antidepressant use varied according to depression status. In particular, men with current MDD were more often treated with antidepressants than women whereas, in both the HDS and the non-depressed groups, antidepressant use was, as has been observed elsewhere, more frequent in women. Gender also had a strong modifying effect on the relationship between antidepressant use and history of major depression. Finally, the direction of the association between antidepressant use and cognitive performance varied according to depression status.
This study showed that the direction and strength of the association between antidepressant use and demographic and health-related factors varied according to the severity of depression symptoms. Further studies are needed to clarify the relationship between gender and cognition and antidepressant use.
本研究旨在确定非抑郁和抑郁老年人使用抗抑郁药的相关因素，并假设这些因素因临床状态而异。
我们研究了7868名年龄在65岁及以上的法国社区居民。采用流行病学研究中心抑郁量表和迷你国际神经精神访谈来定义三组：非抑郁、高抑郁症状和当前重度抑郁症。进行了单独分析以确定每组中与抗抑郁药使用相关的因素。
抗抑郁药的使用（55%为选择性5-羟色胺再摄取抑制剂，25%为三环类抗抑郁药，20%为其他类型）从非抑郁受试者中的4.9%增加到高抑郁症状（HDS）受试者中的17.3%，以及当前重度抑郁症（MDD）患者中的33.6%。与抗抑郁药使用相关的因素因抑郁状态而异。特别是，当前患有MDD的男性比女性更常接受抗抑郁药治疗，而在HDS组和非抑郁组中，正如在其他地方观察到的那样，女性使用抗抑郁药更为频繁。性别对抗抑郁药使用与重度抑郁症病史之间的关系也有很强的调节作用。最后，抗抑郁药使用与认知表现之间关联的方向因抑郁状态而异。
本研究表明，抗抑郁药使用与人口统计学和健康相关因素之间关联的方向和强度因抑郁症状的严重程度而异。需要进一步研究以阐明性别与认知以及抗抑郁药使用之间的关系。
