Parris Michelle S, Marver Julia E, Chaudhury Sadia R, Ellis Steven P, Metts Allison V, Keilp John G, Burke Ainsley K, Oquendo Maria A, Mann Joseph J, Grunebaum Michael F
Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, New York.
Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Int Clin Psychopharmacol. 2018 Sep;33(5):249-254. doi: 10.1097/YIC.0000000000000225.
It is unclear whether anxiety increases or decreases suicidal risk. This may contribute to the lack of guidance on which antidepressant medications are best for suicidal depressed patients who present with high anxiety. This study explored whether anxiety predicts suicidal ideation in depressed individuals treated with paroxetine or bupropion. An 8-week double-blind trial comparing controlled-release paroxetine (N=36) versus extended-release bupropion (N=38) for effect on suicidal ideation and behavior in depressed patients with suicidal ideation, past attempt, or both found an advantage for paroxetine, but anxiety effects were not investigated. This secondary analysis explored the relationship, measured at baseline and weekly, of anxiety with suicidal ideation. Anxiety severity measured weekly correlated with suicidal ideation severity irrespective of treatment (P=0.012). Patients with high baseline anxiety showed a trend toward faster reduction of suicidal ideation with paroxetine compared with bupropion treatment (standard P=0.047; bootstrap P=0.077). The latter finding, if confirmed in larger samples, could enhance choice of antidepressant medication for suicidal, depressed patients presenting with high levels of anxiety.
目前尚不清楚焦虑会增加还是降低自杀风险。这可能导致对于哪些抗抑郁药物最适合伴有高度焦虑的自杀性抑郁症患者缺乏指导。本研究探讨了在接受帕罗西汀或安非他酮治疗的抑郁症患者中，焦虑是否可预测自杀意念。一项为期8周的双盲试验，比较了控释帕罗西汀（N = 36）与缓释安非他酮（N = 38）对有自杀意念、既往有自杀未遂或两者皆有的抑郁症患者自杀意念和行为的影响，结果发现帕罗西汀有优势，但未研究焦虑的影响。这项二次分析探讨了在基线和每周测量时焦虑与自杀意念之间的关系。无论治疗如何，每周测量的焦虑严重程度与自杀意念严重程度相关（P = 0.012）。与安非他酮治疗相比，基线焦虑水平高的患者接受帕罗西汀治疗后自杀意念有更快减轻的趋势（标准P = 0.047；自抽样P = 0.077）。如果在更大样本中得到证实，后一项发现可能会为伴有高度焦虑的自杀性抑郁症患者增强抗抑郁药物的选择。
