General Practice and Primary Health Care Academic Centre, University of Melbourne, Carlton, Victoria, Australia; University Institute of Psychotherapy, Department of Psychiatry-CHUV, University of Lausanne, Switzerland.
General Practice and Primary Health Care Academic Centre, University of Melbourne, Carlton, Victoria, Australia.
J Affect Disord. 2015 May 1;176:125-32. doi: 10.1016/j.jad.2015.01.055. Epub 2015 Feb 2.
Antidepressants are one of the most commonly prescribed drugs in primary care. The rise in use is mostly due to an increasing number of long-term users of antidepressants (LTU AD). Little is known about the factors driving increased long-term use. We examined the socio-demographic, clinical factors and health service use characteristics associated with LTU AD to extend our understanding of the factors that may be driving the increase in antidepressant use.
Cross-sectional analysis of 789 participants with probable depression (CES-D≥16) recruited from 30 randomly selected Australian general practices to take part in a ten-year cohort study about depression were surveyed about their antidepressant use.
165 (21.0%) participants reported <2 years of antidepressant use and 145 (18.4%) reported ≥2 years of antidepressant use. After adjusting for depression severity, LTU AD was associated with: single (OR 1.56, 95%CI 1.05-2.32) or recurrent episode of depression (3.44, 2.06-5.74); using SSRIs (3.85, 2.03-7.33), sedatives (2.04, 1.29-3.22), or antipsychotics (4.51, 1.67-12.17); functional limitations due to long-term illness (2.81, 1.55-5.08), poor/fair self-rated health (1.57, 1.14-2.15), inability to work (2.49, 1.37-4.53), benefits as main source of income (2.15, 1.33-3.49), GP visits longer than 20min (1.79, 1.17-2.73); rating GP visits as moderately to extremely helpful (2.71, 1.79-4.11), and more self-help practices (1.16, 1.09-1.23).
All measures were self-report. Sample may not be representative of culturally different or adolescent populations. Cross-sectional design raises possibility of "confounding by indication".
Long-term antidepressant use is relatively common in primary care. It occurs within the context of complex mental, physical and social morbidities. Whilst most long-term use is associated with a history of recurrent depression there remains a significant opportunity for treatment re-evaluation and timely discontinuation.
抗抑郁药是初级保健中最常用的药物之一。使用量的增加主要是由于长期使用抗抑郁药的人数增加（LTU AD）。对于推动长期使用的因素知之甚少。我们研究了与 LTU AD 相关的社会人口统计学、临床因素和卫生服务利用特征，以扩展我们对可能推动抗抑郁药使用增加的因素的理解。
对从 30 个随机选择的澳大利亚全科医生中招募的 789 名可能患有抑郁症（CES-D≥16）的参与者进行横断面分析，参加一项为期十年的关于抑郁症的队列研究，他们接受了有关抗抑郁药使用情况的调查。
165 名（21.0%）参与者报告使用抗抑郁药<2 年，145 名（18.4%）报告使用抗抑郁药≥2 年。在调整抑郁严重程度后，LTU AD 与：单次（OR 1.56，95%CI 1.05-2.32）或复发性抑郁症发作（3.44，2.06-5.74）；使用 SSRI（3.85，2.03-7.33）、镇静剂（2.04，1.29-3.22）或抗精神病药（4.51，1.67-12.17）；长期疾病导致的功能限制（2.81，1.55-5.08）、健康自评差/一般（1.57，1.14-2.15）、无法工作（2.49，1.37-4.53）、福利作为主要收入来源（2.15，1.33-3.49）、就诊时间长于 20 分钟（1.79，1.17-2.73）；将 GP 就诊评为中度至非常有帮助（2.71，1.79-4.11）和更多的自助实践（1.16，1.09-1.23）。
所有措施均为自我报告。样本可能无法代表不同文化或青少年人群。横断面设计提出了“混杂因素指示”的可能性。
长期使用抗抑郁药在初级保健中较为常见。它发生在复杂的精神、身体和社会病态的背景下。虽然大多数长期使用与复发性抑郁有关，但仍有机会重新评估治疗并及时停药。
