The Institute for Mental and Physical Health and Clinical Translation Strategy Research Centre, Deakin University School of Medicine, Geelong, Australia.
School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
JAMA Psychiatry. 2020 Oct 1;77(10):1012-1020. doi: 10.1001/jamapsychiatry.2020.1214.
Depression is associated with increased inflammation, which may precede its onset, especially in older people. Some preclinical data suggest potential antidepressant effects of aspirin, supported by limited observational data suggesting lower rates of depression in individuals treated with aspirin. There currently appears to be no evidence-based pharmacotherapies for the primary prevention of depression.
To determine whether low-dose aspirin (100 mg) reduces the risk of depression in healthy older adults.
DESIGN, SETTING, AND PARTICIPANTS: This double-blinded, placebo-controlled randomized clinical trial was a substudy of the Aspirin in Reducing Events in the Elderly (ASPREE) trial, which examined if aspirin increased healthy life span, defined as survival free of dementia and disability. The prespecified secondary outcome was depression. Individuals of all races/ethnicities older than 70 years in Australia, as well as white individuals older than 70 years and black and Hispanic individuals older than 65 years in the United States, were included.
Participants were randomized to aspirin (100 mg daily) or placebo, with a median (interquartile range) follow-up of 4.7 (3.5-5.6) years.
The primary outcome was a proxy measure of major depressive disorder defined as a score of 8 or more on the Center for Epidemiologic Studies Depression 10-item (CES-D-10) scale.
Of the 19 114 participants enrolled in the trial, 9525 received aspirin and 9589 received a placebo. The mean (SD) age was 75.2 (4.0) years in the aspirin group and 75.1 (4.5) years in the placebo group; 9531 (56.4%) were women. Participants' demographics and clinical characteristics at baseline were similar between groups. A total of 79 886 annual CES-D-10 measurements were taken, with a mean of 4.2 measurements per participant. There were no significant differences at annual visits in the proportions of CES-D-10 scores of 8 or more between the aspirin and placebo groups. The incidence rate of new CES-D-10 scores of 8 or more was 70.4 events per 1000 person-years in the aspirin group and 69.1 in the placebo group (hazard ratio, 1.02 [95% CI, 0.96-1.08]; P = .54).
Low-dose aspirin did not prevent depression in this large-scale study of otherwise healthy older adults.
ClinicalTrials.gov Identifier: NCT01038583.
抑郁与炎症增加有关，炎症可能先于抑郁发作，尤其是在老年人中。一些临床前数据表明阿司匹林具有潜在的抗抑郁作用，有限的观察性数据也表明，接受阿司匹林治疗的个体中抑郁的发生率较低。目前似乎没有针对抑郁的预防的基于证据的药物治疗。
确定低剂量阿司匹林（100mg）是否可以降低健康老年人患抑郁症的风险。
设计、设置和参与者：这是一项双盲、安慰剂对照随机临床试验，是阿司匹林减少老年人事件（ASPREE）试验的子研究，该试验旨在检查阿司匹林是否能延长健康寿命，即无痴呆和残疾的生存。预先规定的次要结局是抑郁。澳大利亚所有种族/民族的 70 岁以上人群，以及美国的 70 岁以上白种人、65 岁以上黑人和西班牙裔人群都被纳入研究。
参与者被随机分配至阿司匹林（每日 100mg）或安慰剂组，中位（四分位距）随访时间为 4.7（3.5-5.6）年。
主要结局是使用流行病学研究中心抑郁量表 10 项（CES-D-10）的评分 8 分或以上来衡量的主要抑郁障碍的替代指标。
在这项试验中，共有 19114 名参与者，其中 9525 名接受了阿司匹林治疗，9589 名接受了安慰剂治疗。阿司匹林组的平均（SD）年龄为 75.2（4.0）岁，安慰剂组为 75.1（4.5）岁；9531 名（56.4%）为女性。两组参与者的基线人口统计学和临床特征相似。共进行了 79886 次年度 CES-D-10 测量，平均每位参与者进行 4.2 次测量。在每年的就诊中，阿司匹林组和安慰剂组的 CES-D-10 评分达到 8 分或以上的比例没有显著差异。阿司匹林组新出现 CES-D-10 评分达到 8 分或以上的发生率为 70.4 例/1000人年，安慰剂组为 69.1 例/1000 人年（风险比，1.02[95%CI，0.96-1.08]；P=0.54）。
在这项对其他健康老年人进行的大规模研究中，低剂量阿司匹林并未预防抑郁。
ClinicalTrials.gov 标识符：NCT01038583。
