Tournier M, Cougnard A, Boutouaba-Combe S, Verdoux H
Unité Inserm U657, université Victor-Segalen-Bordeaux 2, 146, rue Léo-Saignat, 33076 Bordeaux cedex, France.
Encephale. 2011 May;37 Suppl 1:S36-41. doi: 10.1016/j.encep.2010.06.007. Epub 2010 Aug 30.
Practice guidelines recommend maintaining antidepressant treatment for a long duration (at least six months) after symptomatic improvement. In practice, treatment effectiveness is often jeopardized by non-persistence.
A retrospective cohort study was conducted on a standard sample representative of the members of the French universal health insurance system database, in order to assess antidepressant treatment duration in a real-life setting. 35,053 outpatients who initiated an antidepressant treatment in 2005-2006 were followed up until 2007. Incident antidepressant treatment was defined as no delivery of antidepressant in the six months prior to treatment initiation. Persistence to treatment was defined as antidepressant treatment duration of six months or more. Multivariate analyses were conducted in order to identify characteristics associated with persistence to treatment.
Most antidepressant treatments (n = 28,674; 81.8%) lasted for less than six months and more than half for 28 days at most (n = 20,377; 58.1%). Persistence to treatment was associated with older age (OR 1,13; 95% CI 1.11-1.15), female gender (1.22; 1.15-1.30), chronic disease (1.21; 1.13-1.31), not being on welfare (0.67; 0.60-0.74) and coprescription of anxiolytics (0.36; 0.33-0.38), antipsychotics (0.39; 0.35-0.43) or mood-stabilizers (0.45; 0.39-0.53). Prescribers' specialty was also associated with persistence. Treatments prescribed by general practitioners were less likely to be continued than those prescribed by psychiatrists (1.65; 1.47-1.86).
Non-persistence to antidepressant treatment is very frequent in France. Intervention programs aimed at increasing persistence should target physicians' training and patients' education.
实践指南建议在症状改善后维持长时间（至少六个月）的抗抑郁治疗。在实际操作中，治疗效果常常因治疗不持续而受到影响。
对法国全民医疗保险系统数据库成员的标准样本进行回顾性队列研究，以评估实际生活环境中的抗抑郁治疗时长。对2005年至2006年开始抗抑郁治疗的35053名门诊患者进行随访至2007年。起始抗抑郁治疗定义为在治疗开始前六个月内未使用过抗抑郁药物。治疗持续性定义为抗抑郁治疗时长达到六个月或更长时间。进行多变量分析以确定与治疗持续性相关的特征。
大多数抗抑郁治疗（n = 28674；81.8%）持续时间少于六个月，超过一半的治疗最多持续28天（n = 20377；58.1%）。治疗持续性与年龄较大（比值比1.13；95%置信区间1.11 - 1.15）、女性（1.22；1.15 - 1.30）、慢性病（1.21；1.13 - 1.31）、未领取福利（0.67；0.60 - 0.74）以及同时开具抗焦虑药（0.36；0.33 - 0.38）、抗精神病药（0.39；0.35 - 0.43）或心境稳定剂（0.45；0.39 - 0.53）有关。开处方医生的专业也与治疗持续性有关。全科医生开具的治疗比精神科医生开具的治疗更不容易持续（1.65；1.47 - 1.86）。
在法国，抗抑郁治疗不持续的情况非常普遍。旨在提高治疗持续性的干预项目应针对医生培训和患者教育。
