Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5723, USA.
Department of Psychiatry, Seoul National Hospital, Seoul, South Korea.
J Affect Disord. 2019 Mar 1;246:836-842. doi: 10.1016/j.jad.2018.12.074. Epub 2018 Dec 25.
Antidepressants are common in bipolar disorder (BD), but controversial due to questionable efficacy/tolerability. We assessed baseline antidepressant use/depression associations in BD.
Stanford BD Clinic outpatients, enrolled during 2000-2011, assessed with the Systematic Treatment Enhancement Program for BD (STEP-BD) Affective Disorders Evaluation, were monitored up to two years with the STEP-BD Clinical Monitoring Form while receiving naturalistic expert treatment. Prevalence/correlates of baseline antidepressant use in recovered (euthymic ≥8 weeks)/depressed patients were assessed. Kaplan-Meier survival analyses assessed times to depressive recurrence/recovery in patients with/without baseline antidepressant use, and Cox Proportional Hazard regression analyses assessed covariate effects.
Baseline antidepressant use was significantly (albeit without Bonferroni multiple comparison correction) less among 105 recovered (31.4%) versus 153 depressed (44.4%) patients, and among recovered patients (again without Bonferroni correction), associated with Caucasian race, earlier onset, worse Clinical Global Impression scores, and hastened depressive recurrence (only if mood elevation episodes were not censored), driven by lifetime anxiety disorder, and more (even with Bonferroni correction) bipolar II disorder, lifetime anxiety and eating disorders, and core psychotropics. Baseline antidepressant use among depressed patients was associated with significantly (again without Bonferroni correction) older age, female gender, and more (even with Bonferroni correction) anxiolytics/hypnotics, complex pharmacotherapy, and core psychotropics, but no other unfavorable illness characteristic/current mood symptom, and not time to depressive recovery.
Tertiary BD clinic referral sample receiving open naturalistic expert treatment. Analyses without/with Bonferroni correction.
Additional research is required to assess the complex associations between baseline antidepressant use and longitudinal depressive burden in BD.
抗抑郁药在双相情感障碍（BD）中很常见，但由于疗效/耐受性存在问题，存在争议。我们评估了 BD 患者的基线抗抑郁药使用/抑郁关联。
斯坦福 BD 诊所的门诊患者，于 2000 年至 2011 年期间入组，使用 STEP-BD 情感障碍评估进行评估，并在接受自然主义专家治疗的同时使用 STEP-BD 临床监测表进行长达两年的监测。评估了缓解（≥8 周）/抑郁患者的基线抗抑郁药使用的患病率/相关性。在基线使用和未使用抗抑郁药的患者中，使用 Kaplan-Meier 生存分析评估抑郁复发/缓解的时间，使用 Cox 比例风险回归分析评估协变量的影响。
在 105 名缓解（31.4%）和 153 名抑郁（44.4%）患者中，基线使用抗抑郁药的比例明显（未经 Bonferroni 多重比较校正）较低，在缓解患者中（未经 Bonferroni 校正），与白种人种族、发病较早、临床总体印象评分较差和抑郁复发加快有关（仅当情绪升高发作不被排除时），这是由终身焦虑障碍驱动的，且更易发生（即使经过 Bonferroni 校正）双相 II 型障碍、终身焦虑和饮食障碍，以及核心精神药物。在抑郁患者中，基线使用抗抑郁药与年龄较大、女性性别和更多（即使经过 Bonferroni 校正）抗焦虑药/催眠药、复杂的药物治疗和核心精神药物有关，但与其他不良疾病特征/当前情绪症状无关，也与抑郁缓解时间无关。
三级 BD 诊所转诊样本接受开放自然主义专家治疗。未/经 Bonferroni 校正的分析。
需要进一步研究以评估 BD 中基线抗抑郁药使用与纵向抑郁负担之间的复杂关联。
