Centre for Suicide Research, University of Oxford, Department of Psychiatry, Warneford Hospital, Headington, Oxford, OX3 7JX, United Kingdom.
J Affect Disord. 2010 Jun;123(1-3):95-101. doi: 10.1016/j.jad.2009.10.004. Epub 2009 Oct 28.
Antidepressants are used frequently in non-fatal self-poisoning. There are national guidelines for prescribing antidepressants. There have been few investigations of how non-fatal self-poisoning with antidepressants varies in relation to prescribing and to patient characteristics.
A comparative study of the use of specific antidepressants (amitriptyline and dosulepin (tricyclics), citalopram, fluoxetine, paroxetine and sertraline (selective serotonin reuptake inhibitors) and venlafaxine (serotonin norepinephrine reuptake inhibitor)) for non-fatal self-poisoning (episode-based), relative to prescribing, in three centres in England, 2004 to 2006.
There was marked variation between centres in the ratio of rates of self-poisoning to prescribing for specific antidepressants. Higher rates of self-poisoning relative to prescribing for all antidepressants combined, and for venlafaxine, were found in the centre with greater proportions of patients with a history of self-harm and/or previous psychiatric treatment. Within each centre, higher rates of self-poisoning relative to prescribing were found for citalopram and fluoxetine than amitriptyline. However, rates of self-poisoning relative to prescribing for either amitriptyline or dosulepin were also similar to sertraline, which is of concern given the known toxicity of tricyclics.
An ecological study, where prescriptions were for all indications and not specifically for the patients who self-poisoned.
Marked differences found in ratios of self-poisoning with antidepressants to levels of prescribing, in three centres in England, are likely to reflect differences in both prescribing practices (despite clear national guidance) and patient characteristics. Risk of overdose and toxicity should be considered when local prescribing policy and clinical practice relating to antidepressants are under review.
抗抑郁药在非致命性自伤中经常被使用。有关于抗抑郁药处方的国家指南。但是，很少有调查研究表明，与处方和患者特征相关的情况下，使用抗抑郁药进行非致命性自伤的情况有何不同。
2004 年至 2006 年，在英格兰的三个中心，对特定抗抑郁药（阿米替林和多虑平（三环抗抑郁药）、西酞普兰、氟西汀、帕罗西汀和舍曲林（选择性 5-羟色胺再摄取抑制剂）和文拉法辛（5-羟色胺和去甲肾上腺素再摄取抑制剂）用于非致命性自伤（基于发作）的情况与处方之间的关系进行了基于中心的比较研究。
各中心之间，特定抗抑郁药的自伤与处方比率差异显著。在有自伤和/或既往精神科治疗史的患者比例较高的中心，发现所有抗抑郁药联合以及文拉法辛的自伤相对处方的比率更高。在每个中心内，与阿米替林相比，西酞普兰和氟西汀的自伤相对处方的比率更高。但是，与阿米替林或多虑平相比，舍曲林的自伤相对处方的比率也相似，这令人担忧，因为三环抗抑郁药的毒性是已知的。
这是一项生态研究，处方是针对所有适应症，而不是专门针对自伤的患者。
在英格兰的三个中心，发现抗抑郁药自伤与处方比率存在显著差异，这可能反映了处方实践（尽管有明确的国家指导）和患者特征的差异。在审查与抗抑郁药有关的当地处方政策和临床实践时，应考虑过量风险和毒性。
