Allscripts, Malvern, PA, USA.
Director Medical Informatics Group, Allscripts, 101 Lindenwood Drive, Malvern, PA 19355, USA.
Ther Adv Psychopharmacol. 2015 Jun;5(3):158-65. doi: 10.1177/2045125315577057.
Weight gain as an adverse effect of monotherapy of antidepressant has been well-studied. The effects of augmentation therapy involving multiple antidepressants, on weight changes needs to be adequately addressed.
To study the co-medication effects of bupropion in combination with six individual antidepressants on body mass index (BMI) using EMR based data analysis.
Allscripts data warehouse was used to identify patients on monotherapy of five selective serotonin reuptake inhibitor (SSRI) drugs, escitalopram, sertraline, citalopram, paroxetine, fluoxetine, one selective norepinephrine reuptake inhibitor (SNRI) duloxetine and the aminoketone, bupropion for at least 180 days. We also identified patients on co-medication of SSRI/SNRI drugs with bupropion. Six ANCOVA models were built to compare the short term effects on BMI, among monotherapy and co-medication groups. The patients' clinical conditions and demographics were included to account for confounding effects.
Monotherapy of all the SSRI/SNRI drugs showed significant weight increase, consistent with that of previous studies. The co-medication of bupropion and escitalopram showed a significantly higher increase in BMI than monotherapy (P = 0.0102). The increase in BMI in the other five co-medication groups was not significantly different from their respective monotherapy groups.
Our study reports an adverse weight gain on co-medication of escitalopram and bupropion, which warrants further validation studies. Considering co-medication effects of antidepressants on weight is important to design robust depression treatment plans.
抗抑郁单药治疗的不良反应之一是体重增加，这一现象已经得到了充分研究。而涉及多种抗抑郁药的增效治疗对体重变化的影响则需要得到充分关注。
本研究旨在通过基于电子病历数据的分析，研究安非他酮与六种单药抗抑郁药联合用药对体重指数（BMI）的影响。
使用 Allscripts 数据仓库，我们确定了至少接受过 180 天 5 种选择性 5-羟色胺再摄取抑制剂（SSRIs）药物（艾司西酞普兰、舍曲林、西酞普兰、帕罗西汀、氟西汀）、1 种选择性去甲肾上腺素再摄取抑制剂（SNRI）度洛西汀和氨基酮类药物安非他酮单药治疗的患者，同时还确定了 SSRIs/SNRIs 药物与安非他酮联合用药的患者。建立了 6 个协方差分析模型来比较单药和联合用药组短期 BMI 的影响。将患者的临床状况和人口统计学特征纳入模型以控制混杂因素的影响。
所有 SSRIs/SNRIs 药物的单药治疗均显示出显著的体重增加，与之前的研究结果一致。与单药治疗相比，安非他酮与艾司西酞普兰联合治疗的 BMI 增加更为显著（P = 0.0102）。其他五种联合用药组的 BMI 增加与各自的单药治疗组无显著差异。
本研究报告了艾司西酞普兰和安非他酮联合用药会导致不良的体重增加，这需要进一步的验证研究。考虑到抗抑郁药对体重的联合用药影响对于设计稳健的抑郁症治疗方案非常重要。
