Luo Yan, Kataoka Yuki, Ostinelli Edoardo G, Cipriani Andrea, Furukawa Toshi A
Department of Health Promotion and Human Behavior, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Hospital Care Research Unit, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan.
Front Psychiatry. 2020 Feb 14;11:35. doi: 10.3389/fpsyt.2020.00035. eCollection 2020.
Few studies have delineated the real-world, long-term trends of prescription patterns of antidepressants for patients with major depressive disorder (MDD). This study aims to describe their vicissitudes in the nationally representative sample of the US from 1996 to 2015 and explore their characteristics. We used the Medical Expenditure Panel Survey, a nationally representative database of the US population, between 1996 and 2015. We estimated the prevalence of MDD among adults, calculated the proportions of those on antidepressant treatment as well as those on specific drugs through the two decades, and determined their dosages in 2015. We conducted multivariable regression to find possible factors related to their suboptimal prescriptions. The prevalence of adults diagnosed with MDD increased from 6.1% (95% CI, 5.7-6.6%) in 1996 to 10.4% (9.7-11.1%) in 2015. The proportion of patients without any antidepressant therapy decreased but still accounted for 30.6% (28.3-33.1%) in 2015. Sertraline and fluoxetine were among the most frequently prescribed antidepressants throughout the 20 years, while the trend for some new drugs changed dramatically. 16.1% (12.5-20.2%) of patients of MDD on antidepressant monotherapy were prescribed with suboptimal doses in 2015; the risk was lower for those who had higher Body Mass Index (OR 0.94 [0.90-0.99]), longer-term prescriptions (OR 0.92 [0.87-0.97]), and the risk was higher for those who were prescribed with tricyclic antidepressants (OR 11.21 [2.12-59.34], compared with serotonin reuptake inhibitors (SSRIs)), and antidepressants other than SSRIs and serotonin and norepinephrine reuptake inhibitors (OR 4.12 [1.95, 8.73], compared with SSRIs). This study confirmed the growing numbers of patients with MDD and the increase in the antidepressant prescriptions among them. However, the existence of patients without any antidepressant prescriptions or with suboptimal prescriptions and the variable prescription patterns through the decades might suggest some unresolved gaps between evidence and practice.
很少有研究描述过重度抑郁症（MDD）患者抗抑郁药处方模式的真实世界长期趋势。本研究旨在描述1996年至2015年美国全国代表性样本中这些模式的变化，并探究其特征。我们使用了1996年至2015年期间美国人口的全国代表性数据库——医疗支出面板调查。我们估计了成年人中MDD的患病率，计算了这二十年间接受抗抑郁治疗的人群以及使用特定药物人群的比例，并确定了2015年他们的用药剂量。我们进行了多变量回归分析，以找出与其用药不合理可能相关的因素。被诊断为MDD的成年人患病率从1996年的6.1%（95%CI，5.7 - 6.6%）增至2015年的10.4%（9.7 - 11.1%）。未接受任何抗抑郁治疗的患者比例有所下降，但在2015年仍占30.6%（28.3 - 33.1%）。在这20年里，舍曲林和氟西汀是最常被处方的抗抑郁药，而一些新药的趋势变化显著。2015年，16.1%（12.5 - 20.2%）接受抗抑郁单药治疗的MDD患者被开具了不合理剂量；体重指数较高者（OR 0.94 [0.90 - 0.99]）、长期处方者（OR 0.92 [0.87 - 0.97]）风险较低，而与5-羟色胺再摄取抑制剂（SSRIs）相比，开具三环类抗抑郁药者（OR 11.21 [2.12 - 59.34]）以及开具除SSRIs、5-羟色胺和去甲肾上腺素再摄取抑制剂之外其他抗抑郁药者（OR 4.12 [1.95, 8.73]）风险较高。本研究证实了MDD患者数量的增加以及其中抗抑郁药处方的增多。然而，存在未接受任何抗抑郁药处方或接受不合理处方的患者，以及数十年来不断变化的处方模式，可能表明证据与实践之间存在一些尚未解决的差距。
