Lee Cynthia Wei-Sheng, Lin Cheng-Li, Lin Pan-Yen, Thielke Stephen, Su Kuan-Pin, Kao Chia-Hung
Center for Drug Abuse and Addiction, China Medical University Hospital, China Medical University, Taichung, Taiwan.
Management Office for Health Data, China Medical University Hospital, China Medical University, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan.
Prog Neuropsychopharmacol Biol Psychiatry. 2017 Jul 3;77:83-89. doi: 10.1016/j.pnpbp.2017.04.006. Epub 2017 Apr 7.
To ascertain the relationship between receipt of antidepressant agents and the risk of subsequent dementia in migraine patients. A population-based case-control analysis, using the Taiwan National Health Insurance Research Database. We identified 1774 patients with dementia and 1774 matched nondementia controls from migraine patients enrolled in the Taiwan National Health Insurance program between 2005 and 2011. The proportional distributions of exposure to three classes of antidepressant were compared between dementia and nondementia groups. Univariable and multivariable logistic regression analyses were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the risk of dementia based on antidepressant exposure. The proportions of subjects taking tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and new-generation antidepressants (NGAs) in dementia versus nondementia groups are 52.3 vs 51.2%, 25.5 vs 30.7%, and 18.8 vs 6.26%, respectively. The adjusted ORs of dementia were 1.02 (95% CI=0.89, 1.17; P=0.56) for TCAs, 0.58 (95% CI=0.50, 0.69; P<0.001) for SSRIs, and 4.23 (95% CI=3.34, 5.37; P<0.001) for NGAs. Treatment with SSRIs was associated with a decreased risk of dementia in migraine patients. TCAs showed no association with dementia risk, and NGAs showed increased risk. Given the possibility of confounding by indication, additional prospective trials and basic research are needed before drawing conclusions about the population-level risks for dementia onset conferred by antidepressant medications.
为确定偏头痛患者服用抗抑郁药与后续患痴呆症风险之间的关系。采用基于人群的病例对照分析，利用台湾国民健康保险研究数据库。我们从2005年至2011年参加台湾国民健康保险计划的偏头痛患者中，确定了1774例痴呆症患者和1774例匹配的非痴呆症对照。比较了痴呆症组和非痴呆症组中三类抗抑郁药暴露的比例分布。采用单变量和多变量逻辑回归分析，根据抗抑郁药暴露情况估计痴呆症风险的比值比（OR）和95%置信区间（CI）。痴呆症组与非痴呆症组中服用三环类抗抑郁药（TCA）、选择性5-羟色胺再摄取抑制剂（SSRI）和新一代抗抑郁药（NGA）的受试者比例分别为52.3%对51.2%、25.5%对30.7%和18.8%对6.26%。TCA导致痴呆症的校正OR为1.02（95%CI=0.89，1.17；P=0.56），SSRI为0.58（95%CI=0.50，0.69；P<0.001），NGA为4.23（95%CI=3.34，5.37；P<0.001）。偏头痛患者服用SSRI与痴呆症风险降低相关。TCA与痴呆症风险无关联，而NGA则显示风险增加。鉴于存在指征性混杂的可能性，在得出关于抗抑郁药物在人群层面导致痴呆症发病风险的结论之前，还需要进行额外的前瞻性试验和基础研究。
