Chen Mu-Hong, Pan Tai-Long, Hsu Ju-Wei, Huang Kai-Lin, Su Tung-Ping, Li Cheng-Ta, Lin Wei-Chen, Tsai Shih-Jen, Chang Wen-Han, Chen Tzeng-Ji, Bai Ya-Mei
Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan.
School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan; Liver Research Center, Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Eur Neuropsychopharmacol. 2016 Nov;26(11):1760-1767. doi: 10.1016/j.euroneuro.2016.09.369. Epub 2016 Sep 22.
The comorbidity between attention deficit hyperactivity disorder (ADHD) and major depression is common. However, the influence of ADHD comorbidity in the response or resistance to antidepressants remains unknown among patients with major depression. 1891 patients with major depression and ADHD and 1891 age-/sex-matched patients with major depression only were enrolled and followed for 1 year in our study. Use of antidepressants and ADHD medications during 1-year follow-up period were assessed. Antidepressant resistance was defined as treatment failure in two or more than two different antidepressants for adequate treatment dose and duration. Patients with major depression and ADHD had an increased risk of treatment resistance to antidepressants (odds ratio [OR]: 2.32, 95% confidence interval [CI]: 1.63-3.32) compared with patients with major depression only after adjusting for demographic characteristics and other psychiatric comorbidities. Regular treatment for ADHD would reduce this risk (OR: 1.76, 95% CI: 0.72-4.27). Anxiety (OR: 3.15, 95% CI: 2.24-4.44) and substance use (OR: 2.45, 95% CI: 1.16-5.17) disorders were also associated with an elevated likelihood of resistance to antidepressants during the follow-up. Patients who had dual diagnoses of major depression and ADHD were more likely to have treatment resistance to antidepressants compared with patients with major depression only. Prompt and regular treatment for ADHD would reduce this risk.
注意缺陷多动障碍（ADHD）与重度抑郁症的共病情况很常见。然而，在重度抑郁症患者中，ADHD共病对抗抑郁药反应或抵抗的影响仍不清楚。在我们的研究中，招募了1891例患有重度抑郁症和ADHD的患者以及1891例年龄和性别匹配的仅患有重度抑郁症的患者，并对他们进行了1年的随访。评估了1年随访期内抗抑郁药和ADHD药物的使用情况。抗抑郁药抵抗被定义为在两种或两种以上不同抗抑郁药的适当治疗剂量和疗程下治疗失败。在调整了人口统计学特征和其他精神共病因素后，与仅患有重度抑郁症的患者相比，患有重度抑郁症和ADHD的患者对抗抑郁药产生治疗抵抗的风险增加（优势比[OR]：2.32，95%置信区间[CI]：1.63 - 3.32）。对ADHD进行常规治疗会降低这种风险（OR：1.76，95% CI：0.72 - 4.27）。焦虑症（OR：3.15，95% CI：2.24 - 4.44）和物质使用障碍（OR：2.45，95% CI：1.16 - 5.17）也与随访期间对抗抑郁药抵抗的可能性增加有关。与仅患有重度抑郁症的患者相比，患有重度抑郁症和ADHD双重诊断 的患者更有可能对抗抑郁药产生治疗抵抗。对ADHD进行及时和常规治疗会降低这种风险。
