Guo Michael Y, Etminan Mahyar, Procyshyn Ric M, Kim David D, Samii Ali, Kezouh Abbas, Carleton Bruce C
Departments of Ophthalmology and Visual Sciences.
Psychiatry, and.
J Clin Psychopharmacol. 2018 Aug;38(4):349-356. doi: 10.1097/JCP.0000000000000911.
Antidepressants are one of the most prescribed classes of medications. A number of case reports have linked these drugs to extrapyramidal symptoms (EPSs), but no large epidemiologic study to date has examined this association. We sought to quantify the association of EPSs with different antidepressants by undertaking a large pharmacoepidemiologic study.
A nested case-control study was conducted using a large health claims database in the United States from June 2006 to December 2015. Subjects with a diagnosis of primary Parkinson disease and those who received prescriptions of levodopa, ropinirole, pramipexole, domperidone, metoclopramide, entacapone, benztropine, selegiline, rasagiline, diphenhydramine, trihexyphenidyl, typical and atypical antipsychotics, and tricyclic antidepressants were excluded. Cases were followed to the first billing code for an extrapyramidal event or last date of enrollment in the cohort. For each case, 10 control subjects were matched by follow-up time, calendar time, and age through density-based sampling. Rate ratios were computed using conditional logistic regression adjusting for other covariates.
We identified 3,838 subjects with EPSs compared with 38,380 age-matched control subjects. Rate ratios with respect to EPSs were as follows: duloxetine, 5.68 (95% confidence interval [CI], 4.29-7.53); mirtazapine, 3.78 (95% CI, 1.71-8.32); citalopram, 3.47 (95% CI, 2.68-4.50); escitalopram, 3.23 (95% CI, 2.44-4.26); paroxetine, 3.07 (95% CI, 2.15-4.40); sertraline, 2.57 (95% CI, 2.02-3.28); venlafaxine, 2.37 (95% CI, 1.71-3.29); bupropion, 2.31 (95% CI, 1.67-3.21); and fluoxetine, 2.03 (95% CI, 1.48-2.78).
This observational study demonstrates a harmful association between the incidence of Parkinson disease or associated EPSs and use of the antidepressants duloxetine, mirtazapine, citalopram, escitalopram, paroxetine, sertraline, venlafaxine, bupropion, and fluoxetine.
抗抑郁药是处方量最大的药物类别之一。一些病例报告将这些药物与锥体外系症状（EPS）联系起来，但迄今为止尚无大型流行病学研究对此关联进行检验。我们试图通过开展一项大型药物流行病学研究来量化EPS与不同抗抑郁药之间的关联。
利用美国一个大型健康保险理赔数据库，于2006年6月至2015年12月进行了一项巢式病例对照研究。排除诊断为原发性帕金森病的受试者以及接受左旋多巴、罗匹尼罗、普拉克索、多潘立酮、甲氧氯普胺、恩他卡朋、苯海索、司来吉兰、雷沙吉兰、苯海拉明、苯海索、典型和非典型抗精神病药以及三环类抗抑郁药处方的受试者。对病例随访至锥体外系事件的首个计费代码或队列入组的最后日期。对于每个病例，通过基于密度的抽样，按照随访时间、日历时间和年龄匹配10名对照受试者。使用条件逻辑回归并调整其他协变量来计算率比。
我们识别出3838例有EPS的受试者，与之匹配的是38380名年龄匹配的对照受试者。与EPS相关的率比分别为：度洛西汀5.68（95%置信区间[CI]，4.29 - 7.53）；米氮平3.78（95%CI，1.71 - 8.32）；西酞普兰3.47（95%CI，2.68 - 4.50）；艾司西酞普兰3.23（95%CI，2.44 - 4.26）；帕罗西汀3.07（95%CI，2.15 - 4.40）；舍曲林2.57（95%CI，2.02 - 3.28）；文拉法辛2.37（95%CI，1.71 - 3.29）；安非他酮2.31（95%CI，1.67 - 3.21）；以及氟西汀2.03（95%CI，1.48 - 2.78）。
这项观察性研究表明帕金森病或相关EPS的发生率与使用度洛西汀、米氮平、西酞普兰、艾司西酞普兰、帕罗西汀、舍曲林、文拉法辛、安非他酮和氟西汀这些抗抑郁药之间存在有害关联。
