Kettunen Reetta, Taipale Heidi, Tolppanen Anna-Maija, Tanskanen Antti, Tiihonen Jari, Hartikainen Sirpa, Koponen Marjaana
School of Pharmacy, University of Eastern Finland, PO Box 1627, 70211, Kuopio, Finland.
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, PO Box 1627, 70211, Kuopio, Finland.
Eur J Clin Pharmacol. 2019 Mar;75(3):417-425. doi: 10.1007/s00228-018-2591-5. Epub 2018 Nov 9.
To study how long antidepressants initiated after diagnoses of Alzheimer's disease (AD) were used and factors associated with discontinuation of use among persons with Alzheimer's disease (AD). In addition, differences in duration of use between the antidepressants groups were compared.
Register-based Medication use and Alzheimer's disease (MEDALZ) cohort included 70,718 community-dwelling people with AD who were diagnosed during the years 2005-2011. For this study, the new antidepressant users were included after 1-year washout period (N = 16,501; 68.6% females, mean age 80.9). The duration of antidepressant use was modeled with the PRE2DUP method. Factors associated with treatment discontinuation were assessed with Cox proportional hazard models and included age, gender, comorbid conditions and concomitant medications.
Median duration of the new antidepressant use period was 309 days (IQR 93-830). For selective serotonin reuptake inhibitor (SSRI) use, the median duration was 331 days (IQR 101-829), for mirtazapine 202 days (IQR 52-635), and for serotonin and norepinephrine reuptake inhibitors (SNRIs) 134 days (IQR 37-522). After 1-year follow-up, 40.8% had discontinued antidepressant use, 54.6% after 2 years and 64.1% after 3 years. Factors associated with treatment discontinuation were age over 85, male gender, diabetes, and use of memantine, opioids, and antiepileptics whereas benzodiazepines and related drugs and antipsychotic use were inversely associated with discontinuation.
Antidepressants are used for long-term among people with AD. Need and indication for antidepressant use should be assessed regularly as evidence on their efficacy for behavioral and psychological symptoms of dementia is limited.
研究阿尔茨海默病（AD）诊断后开始使用的抗抑郁药使用时长，以及与阿尔茨海默病患者停药相关的因素。此外，还比较了抗抑郁药组之间使用时长的差异。
基于登记的药物使用与阿尔茨海默病（MEDALZ）队列包括2005年至2011年期间诊断出的70718名社区居住的AD患者。在本研究中，新的抗抑郁药使用者在经过1年洗脱期后纳入（N = 16501；68.6%为女性，平均年龄80.9岁）。抗抑郁药使用时长采用PRE2DUP方法进行建模。使用Cox比例风险模型评估与治疗中断相关的因素，包括年龄、性别、合并症和伴随用药情况。
新抗抑郁药使用期的中位时长为309天（四分位间距93 - 830）。对于选择性5-羟色胺再摄取抑制剂（SSRI）的使用，中位时长为331天（四分位间距101 - 829），米氮平为202天（四分位间距52 - 635），5-羟色胺和去甲肾上腺素再摄取抑制剂（SNRI）为134天（四分位间距37 - 522）。1年随访后，40.8%的人停止使用抗抑郁药，2年后为54.6%，3年后为64.1%。与治疗中断相关的因素包括85岁以上年龄、男性、糖尿病，以及使用美金刚、阿片类药物和抗癫痫药，而使用苯二氮䓬类及相关药物和抗精神病药与停药呈负相关。
抗抑郁药在AD患者中被长期使用。由于抗抑郁药对痴呆行为和心理症状疗效的证据有限，应定期评估使用抗抑郁药的必要性和指征。
