Alonso A, Rodríguez L A García, Logroscino G, Hernán M A
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S Second St, Suite 300, Minneapolis, MN 55416, USA.
J Neurol Neurosurg Psychiatry. 2009 Jun;80(6):671-4. doi: 10.1136/jnnp.2008.152983.
Individuals with depression have a higher risk of Parkinson's disease (PD) but the timing of the association is unknown. Therefore, the relationship between initiation of antidepressant therapy and PD risk was assessed in a large population based database from the UK and the timing of this association was explored.
A case control study nested in the General Practice Research Database cohort, a large computerised database with clinical information from more than 3 million individuals in the UK, was conducted. Cases of PD were identified from the computer records from 1995 to 2001 and matched with up to 10 controls by age, sex and practice. Use of antidepressants was obtained from the computer records.
999 PD cases and 6261 controls were included. The rate ratio (RR) and 95% CI of PD in initiators of antidepressant therapy compared with non-initiators was 1.85 (1.25 to 2.75). The association was stronger during the first 2 years after initiation of medication use (RR 2.19; 95% CI 1.38 to 3.46) than later (RR 1.23; 95% CI 0.57 to 2.67). Results were similar for selective serotonin reuptake inhibitors and tricyclic antidepressants separately.
Initiation of any antidepressant therapy was associated with a higher risk of PD in the 2 years after the start of treatment, which suggests that depressive symptoms could be an early manifestation of PD, preceding motor dysfunction.
抑郁症患者患帕金森病（PD）的风险较高，但这种关联出现的时间尚不清楚。因此，在一个来自英国的大型人群数据库中评估了抗抑郁药治疗开始与PD风险之间的关系，并探讨了这种关联出现的时间。
开展了一项巢式病例对照研究，该研究嵌套于全科医学研究数据库队列中，这是一个大型计算机化数据库，包含来自英国300多万人的临床信息。从1995年至2001年的计算机记录中识别出PD病例，并按年龄、性别和医疗机构与多达10名对照进行匹配。抗抑郁药的使用情况从计算机记录中获取。
纳入了999例PD病例和6261名对照。与未开始使用抗抑郁药的人相比，开始使用抗抑郁药的人患PD的率比（RR）及95%置信区间为1.85（1.25至2.75）。在开始用药后的头2年里这种关联更强（RR 2.19；95%置信区间1.38至3.46），而在之后则较弱（RR 1.23；95%置信区间0.57至2.67）。选择性5-羟色胺再摄取抑制剂和三环类抗抑郁药各自的结果相似。
开始任何抗抑郁药治疗均与治疗开始后2年内患PD的较高风险相关，这表明抑郁症状可能是PD运动功能障碍之前的早期表现。
