Youssef Nagy A, Rich Charles L
University of South Alabama, Mobile, Alabama, USA.
Ann Clin Psychiatry. 2008 Jul-Sep;20(3):157-69. doi: 10.1080/10401230802177698.
Anxiety (among several other symptoms) has been identified in one prospective study as associated with suicide risk in depressed patients early in treatment. It has been suggested that treatment of anxiety in depression with sedative/hypnotic agents, especially benzodiazepines, in the first several weeks may decrease suicide risk. Sedative/hypnotic agents also have depressant and disinhibitory properties which might increase suicide risk, however. This review addresses the potential benefits and risks with regard to suicide of using sedative/hypnotics as an early adjunct to antidepressant treatment in anxious depressed patients.
Pertinent medical literature was reviewed using Medline/PubMed search as well as bibliographies from related publications. Reports in English from 1958 to 2006 were included.
The review did not reveal any evidence that using sedative/hypnotics as an early adjunct to antidepressant treatment of anxious depressed patients decreases their suicide risk. There is considerable evidence that sedative/hypnotics produce depressant and/or disinhibitory effects in a small proportion (perhaps 5%) of people who take them. However, there is no clear evidence that their brief use early in depression increases suicide risk. Toxicological data of suicides indicate that a majority of people who commit suicide are under the influence of sedative/hypnotic chemicals (including alcohol) at the time.
The authors conclude that the question of whether sedative/hypnotics may prevent or provoke suicide in anxious depressed patients cannot be answered definitively with the available information. They believe the potential risks of prescribing sedative/hypnotics for depressed patients who may be suicidal are serious. They suggest that alternatives to sedative/hypnotics should be used if early adjunctive treatment for anxiety in depressed patients is thought to be indicated.
在一项前瞻性研究中，焦虑（与其他几种症状一起）被确定为与治疗早期抑郁症患者的自杀风险相关。有人提出，在治疗的最初几周用镇静/催眠药物，尤其是苯二氮䓬类药物治疗抑郁症中的焦虑，可能会降低自杀风险。然而，镇静/催眠药物也具有抑制和解除抑制的特性，这可能会增加自杀风险。本综述探讨了在焦虑抑郁症患者中使用镇静/催眠药作为抗抑郁治疗早期辅助药物对自杀的潜在益处和风险。
使用Medline/PubMed搜索以及相关出版物的参考文献对相关医学文献进行了综述。纳入了1958年至2006年的英文报告。
该综述未发现任何证据表明，在焦虑抑郁症患者的抗抑郁治疗中早期使用镇静/催眠药会降低其自杀风险。有大量证据表明，镇静/催眠药在一小部分（可能5%）服用者中会产生抑制和/或解除抑制作用。然而，没有明确证据表明在抑郁症早期短期使用它们会增加自杀风险。自杀的毒理学数据表明，大多数自杀者在自杀时受到镇静/催眠化学物质（包括酒精）的影响。
作者得出结论，根据现有信息无法明确回答镇静/催眠药是否可以预防或引发焦虑抑郁症患者自杀的问题。他们认为，为可能有自杀倾向的抑郁症患者开镇静/催眠药的潜在风险很大。他们建议，如果认为有必要对抑郁症患者的焦虑进行早期辅助治疗，应使用镇静/催眠药的替代药物。
