Shankman Stewart A, Gorka Stephanie M, Katz Andrea C, Klein Daniel N, Markowitz John C, Arnow Bruce A, Manber Rachel, Rothbaum Barbara O, Thase Michael E, Schatzberg Alan F, Keller Martin B, Trivedi Madhukar H, Kocsis James H
University of Illinois at Chicago, 1007 W Harrison St (M/C 285), Chicago, IL 60607.
Department of Psychology, University of Illinois at Chicago, Chicago, Illinois, USA.
J Clin Psychiatry. 2017 Apr;78(4):433-440. doi: 10.4088/JCP.15m10370.
Side effects to antidepressant medication can affect the efficacy of treatment, but few predictors foretell who experiences side effects and which side effects they experience. This secondary data analysis examined whether depressed patients with comorbid panic disorder were more likely to experience side effects than those without panic disorder. The study also examined whether greater burden of side effects predicted a poorer treatment course for patients with panic disorder than those without panic disorder. To examine the specificity of these effects, analyses also examined 2 other anxiety disorders-social phobia and generalized anxiety disorder (GAD).
Between 2002 and 2006, a large sample (N = 808) of chronically depressed individuals (assessed using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders [SCID-IV]) received antidepressants according to a predetermined algorithm for 12 weeks. Every 2 weeks, depressive symptoms (per the Hamilton Depression Rating Scale) and side effects (specific side effects as well as several indicators of side effect burden) were assessed.
Lifetime diagnosis of panic disorder (assessed using the SCID-IV) at baseline was associated with higher likelihood of gastrointestinal (OR = 1.6 [95% CI, 1.0-2.6]), cardiac (OR = 1.8 [95% CI, 1.1-3.1]), neurologic (OR = 2.6 [95% CI, 1.6-4.2]), and genitourinary side effects (OR = 3.0 [95% CI, 1.7-5.3]) during treatment. Increases in side effect frequency, intensity, and impairment over time were more strongly associated with increases in depressive symptoms for patients with panic disorder compared to those without panic disorder. Neither social phobia nor GAD was associated with these effects.
Potentially due to heightened interoceptive awareness of changes in their body, chronically depressed individuals with panic disorder may be at greater risk than those without panic disorder for antidepressant side effects and to experience a worsening of depressive symptoms as a result of these side effects over time.
ClinicalTrials.gov identifier: NCT00057551.
抗抑郁药物的副作用会影响治疗效果，但很少有预测因素能预先判断谁会出现副作用以及会出现哪些副作用。这项二次数据分析研究了合并惊恐障碍的抑郁症患者是否比未患惊恐障碍的患者更易出现副作用。该研究还考察了与未患惊恐障碍的患者相比，更大的副作用负担是否预示着患惊恐障碍的患者治疗过程更差。为检验这些影响的特异性，分析还考察了另外两种焦虑症——社交恐惧症和广泛性焦虑症（GAD）。
在2002年至2006年期间，一大样本（N = 808）的慢性抑郁症患者（使用《精神疾病诊断与统计手册》第四版修订版轴I障碍的结构化临床访谈[SCID-IV]进行评估）按照预定算法接受了12周的抗抑郁药物治疗。每2周评估一次抑郁症状（根据汉密尔顿抑郁量表）和副作用（特定副作用以及副作用负担的几个指标）。
基线时终生诊断为惊恐障碍（使用SCID-IV评估）与治疗期间出现胃肠道副作用（比值比[OR]=1.6[95%置信区间，1.0 - 2.6]）、心脏副作用（OR = 1.8[95%置信区间，1.1 - 3.1]）、神经副作用（OR = 2.6[95%置信区间，1.6 - 4.2]）和泌尿生殖系统副作用（OR = 3.0[95%置信区间，1.7 - 5.3]）的可能性更高相关。与未患惊恐障碍的患者相比，患惊恐障碍的患者随着时间推移副作用频率、强度和损害的增加与抑郁症状的增加更密切相关。社交恐惧症和广泛性焦虑症均与这些影响无关。
长期患有惊恐障碍的抑郁症患者可能比未患惊恐障碍的患者因抗抑郁药物副作用面临更大风险，且随着时间推移会因这些副作用导致抑郁症状恶化，这可能是由于他们对身体变化的内感受性意识增强。
ClinicalTrials.gov标识符：NCT00057551。
