Department of Psychiatry, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea.
Department of Psychiatry and Behavioral Science, Institute of Human Behavioral Medicine, Seoul National University College of Medicine, Jongno-gu, Seoul, Republic of Korea.
PLoS One. 2019 Sep 25;14(9):e0222791. doi: 10.1371/journal.pone.0222791. eCollection 2019.
The duration of antidepressant use affects the treatment of depression. Using the National Health Insurance database, which covers almost the entire national population, we verified the factors associated with the inadequate short-term use of initially prescribed antidepressants and their effects on the relapse and recurrence of depressive episodes.
There were 752,190 patients included who had been newly prescribed antidepressants in 2012 with the diagnosis of depressive disorder. They were followed-up until December 31, 2015. They were classified as short-term and long-term antidepressant users depending on whether they used a specific initial antidepressant for at least four weeks. Sociodemographic, clinical, and medical utilization factors affecting the duration of antidepressant use were investigated. We also identified whether the duration of antidepressant use affected the risk of relapse and recurrence, which was defined by the restarting of antidepressants.
Initial antidepressants were taken for less than 28 days by 458,057 (60.84%) patients. Tricyclic antidepressants were used as the initial antidepressant more frequently than selective serotonin reuptake inhibitors (64.5% versus 19.3%). The type of initial antidepressant, polypharmacy, psychiatric and medical comorbidities, type of insurance coverage, and type of medical institution visited were associated with short-term use. Short-term use marginally increased the risk of relapse and recurrence of depressive episodes (Hazard ratio: 1.06, 95% confidence intervals 1.048-1.075).
Short-term antidepressant use is widespread in Korea, and assessment in various aspects are necessary to set proper treatment plans.
抗抑郁药的使用时间长短会影响抑郁症的治疗。我们利用涵盖了几乎全国人口的全民健康保险数据库，验证了与最初处方的抗抑郁药短期使用不足相关的因素，以及它们对抗抑郁发作复发和再发的影响。
共纳入 752190 例 2012 年新被诊断为抑郁症并开始服用抗抑郁药的患者，随访至 2015 年 12 月 31 日。根据他们是否至少使用特定初始抗抑郁药 4 周，将他们分为短期和长期抗抑郁药使用者。我们调查了影响抗抑郁药使用时间的社会人口学、临床和医疗利用因素。我们还确定了抗抑郁药使用时间是否会影响复发和再发的风险，复发和再发的定义是重新开始使用抗抑郁药。
458057 名（60.84%）患者的初始抗抑郁药使用时间不到 28 天。三环类抗抑郁药作为初始抗抑郁药的使用频率高于选择性 5-羟色胺再摄取抑制剂（64.5%比 19.3%）。初始抗抑郁药的类型、联合用药、精神和医学合并症、保险类型和就诊医疗机构类型与短期使用有关。短期使用略微增加了抑郁发作复发和再发的风险（危险比：1.06，95%置信区间 1.048-1.075）。
在韩国，短期使用抗抑郁药的情况很普遍，需要从各个方面进行评估，以制定适当的治疗计划。
