McIntyre Roger S, Weiller Emmanuelle
University of Toronto, Toronto, ON, Canada,
Adv Ther. 2015 May;32(5):429-44. doi: 10.1007/s12325-015-0207-3. Epub 2015 May 13.
Patients with major depressive disorder (MDD) often fail to respond to first-line antidepressant treatments (ADTs); subsequent strategies include dosage increase, switch to a different ADT, or addition of another ADT or other drug. The objective of this prospective, case review study was to identify factors that influence the decision to prescribe adjunctive antipsychotics for patients with MDD and inadequate response to ADT.
Psychiatrists or primary care physicians (n=411) based in the USA and Europe each completed an online survey for ten consecutive adults with MDD and inadequate response to ADTs, and for whom a treatment change was considered. A t test was used to compare survey responses between groups of patients.
The survey was completed for 4018 patients; an adjunctive antipsychotic was considered for 961/4018 patients (23.9%) and actually prescribed for 514/4018 (12.8%). Compared with patients not considered for an adjunctive antipsychotic, those who were considered for this treatment had more previous major depressive episodes (MDEs), longer duration of the current MDE, more severe illness both at ADT initiation and current consultation, and more treatment changes. Patients who were prescribed adjunctive antipsychotics had at baseline more functional impairment and absences from work than those considered for but not prescribed this treatment. Key symptoms that prompted physicians to consider antipsychotics were psychotic symptoms, psychomotor agitation, hostility, irritability, impulsivity, and anger bursts. Anxious mood and irritability were mentioned significantly more often by physicians who actually prescribed adjunctive antipsychotics. Obstacles to prescribing included a tendency to wait to see if symptoms improved and concern over side effects.
This real-world study suggested that the decision to prescribe an adjunctive antipsychotic for patients with MDD and inadequate response to ADT is influenced by a broad spectrum of factors, predominantly related to severity of illness, functional impairment, and symptom profile.
Otsuka Pharmaceutical Development & Commercialization, Inc. (Princeton, USA) and H. Lundbeck A/S (Valby, Denmark).
重度抑郁症（MDD）患者常常对一线抗抑郁治疗（ADT）没有反应；后续策略包括增加剂量、换用另一种ADT、或加用另一种ADT或其他药物。这项前瞻性病例回顾研究的目的是确定影响为对ADT反应不足的MDD患者开具辅助性抗精神病药物这一决策的因素。
美国和欧洲的精神科医生或初级保健医生（n = 411）分别对连续10名患有MDD且对ADT反应不足、并考虑进行治疗调整的成年患者完成了一项在线调查。采用t检验比较患者组之间的调查回复。
共对4018名患者完成了调查；961/4018名患者（23.9%）被考虑使用辅助性抗精神病药物，其中514/4018名患者（12.8%）实际开具了此类药物。与未被考虑使用辅助性抗精神病药物的患者相比，被考虑使用该治疗方法的患者既往有更多的重度抑郁发作（MDE）、当前MDE的持续时间更长、在开始ADT治疗时和当前会诊时病情都更严重，且治疗调整更多。与被考虑使用但未开具辅助性抗精神病药物的患者相比，实际开具此类药物的患者在基线时功能损害更严重且缺勤更多。促使医生考虑使用抗精神病药物的关键症状包括精神病性症状、精神运动性激越、敌意、易怒、冲动和突发愤怒。实际开具辅助性抗精神病药物的医生提及焦虑情绪和易怒的频率显著更高。开具药物的障碍包括倾向于等待观察症状是否改善以及对副作用的担忧。
这项真实世界研究表明，为对ADT反应不足的MDD患者开具辅助性抗精神病药物的决策受到广泛因素的影响，主要与疾病严重程度、功能损害和症状特征有关。
大冢制药开发与商业化公司（美国普林斯顿）和H. 伦贝克公司（丹麦瓦尔比）。
