Department of Community Medicine and Health Care, School of Medicine, University of Connecticut, 263 Farmington Avenue, Farmington, CT 06030, United States; Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, United States; Veterans Affairs (VA) New England Mental Illness Research, Education and Clinical Centers (MIRECC), West Haven, CT, United States; Veterans Affairs (VA) Connecticut Healthcare System, West Haven, CT, United States.
Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, United States; Veterans Affairs (VA) New England Mental Illness Research, Education and Clinical Centers (MIRECC), West Haven, CT, United States; Veterans Affairs (VA) Connecticut Healthcare System, West Haven, CT, United States.
J Affect Disord. 2019 Jun 1;252:450-457. doi: 10.1016/j.jad.2019.04.018. Epub 2019 Apr 8.
Both psychiatric polypharmacy and multimorbidity are common in depressed adults. We examine recent patterns of psychotropic polypharmacy with attention to concurrent multimorbidity in the treatment of depressive disorders in outpatient psychiatric care.
Data from the 2006-2015 National Ambulatory Medical Care Survey offer nationally representative samples of office-based psychiatric care in adults with depressive disorders (ICD-9-CM codes 296.20-296.26, 296.30-296.36, 300.4, 311, and 301.10-301.13) (n = 6,685 unweighted). These data allowed estimation of the prevalence of polypharmacy (within-class, between-class, and both) involving four major psychotropic classes: antidepressants, antipsychotics, mood-stabilizers, and sedative-hypnotics. We further evaluated the proportion of within-class and between-class psychotropic prescription combinations that were potentially justifiable, taking FDA-approved indications and multimorbidity into consideration.
Prescribing two or more psychotropic medications for depressed adults remained substantial and stable ranging from 59.0% in 2006-2007 to 58.0% in 2014-2015. The most common within-class polypharmacy types were: antidepressants (22.7%) and sedative-hypnotics (14.8%). The most common between-class polypharmacy types were: an antidepressant and a sedative-hypnotic (30.7%), an antidepressant and an antipsychotic (16.4%), and an antipsychotic and a sedative-hypnotic (9.0%). In visits in which between-class psychotropics were prescribed, 53.9% were potentially justified by FDA-approved augmentation and/or adjunctive treatment strategies or by psychiatric multimorbidities.
Psychotropic polypharmacy affects more than half of depressed adults. Between-class polypharmacy is the most common pattern and in over 50% of instances may be justified by augmentation strategies or considerations of psychiatric multimorbidity. Future research is needed to address effectiveness, safety, and cost-effectiveness of polypharmaceutical care for depression, especially those occurring with psychiatric co-morbididities.
精神科药物的联合应用和共病在抑郁成年患者中都很常见。我们研究了在门诊精神科治疗中抗抑郁障碍治疗中最近的精神药物联合应用模式，同时关注共病。
来自 2006-2015 年全国门诊医疗调查的数据提供了具有全国代表性的抑郁障碍门诊精神科治疗成年人样本（ICD-9-CM 代码 296.20-296.26、296.30-296.36、300.4、311 和 301.10-301.13）（n=6685 未加权）。这些数据允许估算涉及四大精神药物类别（抗抑郁药、抗精神病药、心境稳定剂和镇静催眠药）的联合用药（类内、类间和两者）的流行率。我们进一步评估了考虑到 FDA 批准的适应症和共病的情况下，类内和类间精神药物处方组合中潜在合理的比例。
为抑郁成年患者开两种或两种以上精神药物的情况仍然很多且稳定，从 2006-2007 年的 59.0%到 2014-2015 年的 58.0%。最常见的类内联合用药类型是：抗抑郁药（22.7%）和镇静催眠药（14.8%）。最常见的类间联合用药类型是：抗抑郁药和镇静催眠药（30.7%）、抗抑郁药和抗精神病药（16.4%）以及抗精神病药和镇静催眠药（9.0%）。在开具类间精神药物的就诊中，53.9%可能通过 FDA 批准的增效和/或辅助治疗策略或通过精神共病来证明合理。
精神科药物联合应用影响超过一半的抑郁成年人。类间联合用药是最常见的模式，超过 50%的情况下可能通过增效策略或考虑精神共病来证明合理。需要进一步研究针对抑郁症的多药治疗的有效性、安全性和成本效益，特别是与精神共病相关的情况。
