Pisa Federica Edith, Logroscino Giancarlo, Casetta Anica, Cecotti Laura, Verriello Lorenzo, Bratina Alessio, Sartori Arianna, Lazzarino de Lorenzo Lucio, Eleopra Roberto, Barbone Fabio
Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy.
Neuroepidemiology. 2015;44(2):91-8. doi: 10.1159/000374119. Epub 2015 Mar 5.
The prevalent use of antidepressants (ATDs) in patients with Amyotrophic Lateral Sclerosis (ALS) varies across cross-sectional and clinic-based published studies. This population-based cohort study assesses the real-world prevalence of the use of ATDs, its trajectory and the association of incident use with clinical characteristics.
All patients with incident ALS in the Friuli Venezia Giulia region, Italy, from 2002 to 2009, were identified through multiple sources including health databases. Diagnosis was validated through clinical documentation review. ATDs prescriptions from 2000 to 2011 were obtained from regional database. The trajectory was estimated through generalized estimating equations for repeated measures logistic regression and the Hazard ratio (HR) of initiating ATDs through multivariate proportional hazard Cox regression.
In this cohort of 261 ALS cases, age-, sex-adjusted prevalence of the use of ATDs was 37.3%, higher than in general population. The trajectory increased by 16% in 1-year period across diagnosis. Age ≤67 years at diagnosis (HR 1.28, 95% CI 0.84-1.95) and bulbar onset (1.43, 95% CI 0.90-2.26) were positively associated with initiating ATDs after diagnosis.
More than one-third of patients used ATDs. Depression may occur more frequently than previously reported. Depression may precede motor alterations and be related to both ALS diagnosis and progression.
肌萎缩侧索硬化症（ALS）患者中抗抑郁药（ATD）的普遍使用情况在横断面研究和基于临床的已发表研究中存在差异。这项基于人群的队列研究评估了ATD使用的真实世界患病率、其变化轨迹以及首次使用与临床特征之间的关联。
通过包括健康数据库在内的多种来源，识别出2002年至2009年意大利弗留利-威尼斯朱利亚地区所有新发ALS患者。通过临床文档审查验证诊断。从区域数据库获取2000年至2011年的ATD处方。通过重复测量逻辑回归的广义估计方程估计变化轨迹，并通过多变量比例风险Cox回归估计开始使用ATD的风险比（HR）。
在这个包含261例ALS病例的队列中，经年龄、性别调整后的ATD使用率为37.3%，高于一般人群。在诊断后的1年时间里，变化轨迹增加了16%。诊断时年龄≤67岁（HR 1.28，95%CI 0.84 - 1.95）和延髓起病（1.43，95%CI 0.90 - 2.26）与诊断后开始使用ATD呈正相关。
超过三分之一的患者使用了ATD。抑郁症的发生可能比之前报道的更频繁。抑郁症可能先于运动改变出现，并且与ALS诊断和病情进展均有关。
