Department of Veterans Affairs, Ann Arbor Center of Excellence (COE), Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), Ann Arbor, Michigan, USA.
Pharmacoepidemiol Drug Saf. 2010 Oct;19(10):1049-56. doi: 10.1002/pds.1985.
Naturalistic studies comparing differences in risks across antidepressant agents must take into account factors which influence selection of specific agents and may be associated with outcomes. We examined predictors of antidepressant choice among VA patients treated for depression.
Retrospective cohort study of VA patients with depression diagnoses and a new start of one of the seven most commonly prescribed antidepressant agents between 1 April 1999 and 30 September 2004 (n = 502 179). We examined the relationship between patient and facility characteristics and new starts of bupropion, citalopram, fluoxetine, mirtazapine, paroxetine, sertraline, and venlafaxine. We also examined factors associated with new starts only among patients starting selective serotonin reuptake inhibitors (SSRIs).
Thirty-three percent of patients starting mirtazapine had at least three outpatient mental health visits in the prior year, compared to ≤ 24% of patients prescribed other antidepressants. Patients starting mirtazapine were also most likely to have received at least two other psychotropic medications in the prior year. Of the four SSRIs, 40% of the patients receiving sertraline and only 31% of those receiving fluoxetine were 65 years or older. A comorbid anxiety disorder (other than post-traumatic stress disorder) was diagnosed in 21% of paroxetine patients compared with ≤ 15% of other SSRI patients.
Choice of antidepressant medication for depressed VA patients was associated with important differences in demographic and clinical variables, including psychiatric illness severity, older age, and likelihood of a comorbid anxiety disorder. These findings emphasize the importance of controlling for selection bias when using observational data to compare risks from or effect of mental health treatments.
比较抗抑郁药物风险差异的自然主义研究必须考虑影响特定药物选择的因素，这些因素可能与结果相关。我们研究了退伍军人事务部（VA）患者中影响抗抑郁药物选择的预测因素。
对 1999 年 4 月 1 日至 2004 年 9 月 30 日期间被诊断为抑郁症且新开始使用七种最常开处方的抗抑郁药之一的 VA 患者进行回顾性队列研究（n=502179）。我们检查了患者和医疗机构特征与丁胺苯丙酮、西酞普兰、氟西汀、米氮平、帕罗西汀、舍曲林和文拉法辛新处方之间的关系。我们还检查了仅在开始选择性 5-羟色胺再摄取抑制剂（SSRIs）的患者中新处方相关的因素。
33%开始使用米氮平的患者在过去一年中有至少三次门诊心理健康就诊，而接受其他抗抑郁药治疗的患者≤24%。开始使用米氮平的患者在过去一年中也最有可能接受至少两种其他精神药物治疗。在四种 SSRIs 中，40%接受舍曲林的患者和仅 31%接受氟西汀的患者年龄在 65 岁或以上。与其他 SSRI 患者≤15%相比，接受帕罗西汀治疗的患者中有 21%被诊断出患有焦虑症（除创伤后应激障碍外）。
退伍军人事务部患者抗抑郁药物的选择与重要的人口统计学和临床变量差异相关，包括精神疾病严重程度、年龄较大和合并焦虑症的可能性。这些发现强调了在使用观察数据比较心理健康治疗的风险或效果时，控制选择偏差的重要性。
