McIntyre Roger S, Ng-Mak Daisy, Chuang Chien-Chia, Halpern Rachel, Patel Pankaj A, Rajagopalan Krithika, Loebel Antony
University of Toronto, MDPU-BCDF, Toronto, Canada.
Sunovion Pharmaceuticals Inc., Marlborough, MA, USA.
J Affect Disord. 2017 Mar 1;210:332-337. doi: 10.1016/j.jad.2016.12.033. Epub 2016 Dec 23.
To compare outcomes for individuals with major depressive disorder (MDD) with or without subthreshold hypomania (mixed features) in naturalistic settings.
Using the Optum Research Database (1/1/2009─10/31/2014), a retrospective analysis of individuals newly diagnosed with MDD was conducted. Continuous enrollment for 12-months before and after the initial MDD diagnosis was required. MDD with subthreshold hypomania (mixed features) (MDD-MF) was defined based on ≥1 hypomania diagnosis within 30 days after an MDD diagnosis during the one-year follow-up period, in the absence of bipolar I diagnoses. Psychiatric medication use, healthcare utilization, and costs during the one-year follow-up period were compared using multivariate logistic and gamma regressions, controlling for baseline differences.
Of 130,626 MDD individuals, 652 (0.5%) met the operational definition of MDD-MF. Compared to the MDD-only group, the MDD-MF group had more suicidality (2.0% vs. 0.5%), anxiety disorders (46.8% vs. 34.0%), and substance use disorders (15.5% vs. 6.1%, all P<0.001). More individuals with MDD-MF were treated with antidepressants (83.6% vs. 71.6%), mood stabilizers (50.5% vs. 2.7%), atypical antipsychotics (39.0% vs. 5.5%), and polypharmacy with multiple drug classes (72.1% vs. 22.7%, all P<0.001). Individuals with MDD-MF had higher hospitalizations rates (24.2% vs. 10.5%) and total healthcare costs (mean: $15,660 vs. $10,744, all P<0.001).
The commercial claims data used were not collected for research purposes and may over- or under-represent certain populations. No specific claims-based diagnostic code for MDD with mixed features exists.
Greater use of mood stabilizers, atypical antipsychotics, polypharmacy, and healthcare resources provides evidence of the complexity and severity of MDD-MF. Identifying optimal treatment regimens for this population represents a major unmet medical need.
比较在自然环境中患有或不患有阈下轻躁狂（混合特征）的重度抑郁症（MDD）患者的结局。
利用Optum研究数据库（2009年1月1日至2014年10月31日），对新诊断为MDD的患者进行回顾性分析。要求在首次MDD诊断前后连续登记12个月。阈下轻躁狂（混合特征）的MDD（MDD-MF）定义为在一年随访期内，MDD诊断后30天内有≥1次轻躁狂诊断，且无双相I型诊断。使用多变量逻辑回归和伽马回归比较一年随访期内的精神科药物使用、医疗保健利用和费用，并控制基线差异。
在130,626例MDD患者中，652例（0.5%）符合MDD-MF的操作定义。与仅患MDD的组相比，MDD-MF组有更多的自杀倾向（2.0%对0.5%）、焦虑症（46.8%对34.0%）和物质使用障碍（15.5%对6.1%，均P<0.001）。更多的MDD-MF患者接受了抗抑郁药治疗（83.6%对71.6%）、心境稳定剂治疗（50.5%对2.7%）、非典型抗精神病药物治疗（39.0%对5.5%）以及多种药物联合治疗（72.1%对22.7%，均P<0.001）。MDD-MF患者的住院率更高（24.2%对10.5%），总医疗费用更高（平均：15,660美元对10,744美元，均P<0.001）。
所使用的商业索赔数据并非为研究目的而收集，可能会高估或低估某些人群。不存在基于特定索赔的混合特征MDD诊断代码。
更多地使用心境稳定剂、非典型抗精神病药物、联合用药和医疗资源，证明了MDD-MF的复杂性和严重性。确定该人群的最佳治疗方案是一项重大的未满足医疗需求。
