Li Kanglai, Wei Qinling, Li Guanying, He Xiangjun, Liao Yingtao, Gan Zhaoyu
Very Important Patient Department.
Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe District, Guangzhou, Guangdong, People's Republic of China.
Patient Prefer Adherence. 2016 Oct 31;10:2209-2215. doi: 10.2147/PPA.S109941. eCollection 2016.
Medication nonadherence remains a big challenge for depressive patients. This study aims to assess and compare the medication persistence between unipolar depression (UD) and bipolar depression (BD).
A total of 146 UD and 187 BD patients were recruited at their first index prescription. Time to lack of persistence with pharmacological treatment (defined as a gap of at least 60 days without taking any medication) was calculated, and clinical characteristics were collected. Final diagnosis was made at the end of 1-year follow-up.
A total of 101 (69.2%) UD and 126 (67.4%) BD patients discontinued the treatment, with a median duration of 36 days and 27 days, respectively. No significant difference was found between UD and BD in terms of time to lack of persistence with pharmacological treatment. The highest discontinuation rate (>40%) occurred in the first 3 months for both groups of patients. For UD patients, those with a higher risk of suicide (odds ratio [OR] =0.696, =0.035) or comorbidity of any anxiety disorder (OR =0.159, <0.001) were less likely to prematurely drop out (drop out within the first 3 months), while those with onset in the summer (OR =4.702, =0.049) or autumn (OR =7.690, =0.012) were more likely to prematurely drop out than those with onset in the spring (OR =0.159, <0.001). For BD patients, being female (OR =2.250, =0.012) and having a history of spontaneous remission or switch to hypomania (OR =2.470, =0.004) were risk factors for premature drop out, while hospitalization (OR =0.304, =0.023) and misdiagnosis as UD (OR =0.283, <0.001) at the first index prescription were protective factors.
Conservative definition of nonadherence, low representativeness of sample.
Treatment discontinuation was frequently seen in patients with UD or BD, especially in the first 3 months of treatment. In spite of the similar pattern of medication persistence, UD and BD differ from each other in predictors of premature drop out.
药物治疗依从性差仍是抑郁症患者面临的一大挑战。本研究旨在评估并比较单相抑郁（UD）和双相抑郁（BD）患者的药物治疗持续性。
共招募了146例UD患者和187例BD患者，均为首次开具索引处方。计算药物治疗持续性缺乏的时间（定义为至少60天未服用任何药物的间隔期），并收集临床特征。在1年随访结束时做出最终诊断。
共有101例（69.2%）UD患者和126例（67.4%）BD患者中断治疗，中位持续时间分别为36天和27天。在药物治疗持续性缺乏时间方面，UD和BD之间未发现显著差异。两组患者在前3个月的停药率最高（>40%）。对于UD患者，自杀风险较高（比值比[OR]=0.696，P=0.035）或合并任何焦虑症（OR=0.159，P<0.001）的患者过早停药（在前3个月内停药）的可能性较小，而夏季发病（OR=4.702，P=0.049）或秋季发病（OR=7.690，P=0.012）的患者比春季发病的患者（OR=0.159，P<0.001）更易过早停药。对于BD患者，女性（OR=2.250，P=0.012）以及有自发缓解或转为轻躁狂病史（OR=2.470，P=0.004）是过早停药的危险因素，而首次开具索引处方时住院治疗（OR=0.304，P=0.023）和误诊为UD（OR=0.283，P<0.001）是保护因素。
对不依从的定义保守，样本代表性低。
UD或BD患者中频繁出现治疗中断，尤其是在治疗的前3个月。尽管药物治疗持续性模式相似，但UD和BD在过早停药的预测因素方面存在差异。
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