老年焦虑和抑郁障碍患者接受抗抑郁药治疗时的苯二氮䓬类药物联合处方：与治疗结局的关系。

Coprescribed Benzodiazepines in Older Adults Receiving Antidepressants for Anxiety and Depressive Disorders: Association With Treatment Outcomes.

机构信息

Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.

Department of Psychiatry, University of Pittsburgh, 3811 O'Hara St, Pittsburgh, PA 15213.

出版信息

J Clin Psychiatry. 2020 Sep 29;81(6):20m13283. doi: 10.4088/JCP.20m13283.

DOI:10.4088/JCP.20m13283

PMID:32991792

Abstract

OBJECTIVE

There is a paucity of data on the effects of coprescribed benzodiazepines on treatment response variability and adherence to antidepressant pharmacotherapy for depression and anxiety in late life. The objective of this transdiagnostic analysis was to examine the effect of benzodiazepines on treatment outcomes in older patients with generalized anxiety disorder (GAD) or major depressive disorder (MDD).

METHODS

Secondary analyses of data from 2 clinical trials of antidepressant pharmacotherapy for GAD (escitalopram vs placebo, 2006-2009) or MDD (open treatment with venlafaxine, 2009-2014) were conducted. Participants included 640 adults aged 60+ years with DSM-IV-defined GAD (n = 177) or MDD (n = 463). Benzodiazepine data were collected at baseline. Adherence and treatment response were assessed over 12 weeks. The analysis addressed whether coprescribed benzodiazepines are associated with treatment response, antidepressant medication adherence, dropout, final dose of antidepressant medication, and report of antidepressant-related adverse effects.

RESULTS

Participants with GAD and coprescribed benzodiazepines were treated with a lower mean dosage of escitalopram and were less likely to complete the trial; there was no difference in adherence or treatment response. Participants with MDD and coprescribed benzodiazepines were less likely to tolerate a therapeutic dose of venlafaxine and reported more medication-related adverse effects; there was no difference in adherence, dropout, or treatment response.

CONCLUSIONS

Coprescription of benzodiazepines was associated with increased dropout in older patients with GAD and more medication-related adverse effects in older patients with MDD. However, with the systematic clinical attention offered in a clinical trial, they do not impede treatment response. Clinicians should be aware that a coprescribed benzodiazepine may be a marker of a more challenging treatment course.

TRIAL REGISTRATION

Data analyzed were from studies with ClinicalTrials.gov identifiers NCT00892047 and NCT00105586.

摘要

目的

关于合并使用苯二氮䓬类药物对老年患者抑郁症和焦虑症的抗抑郁药物治疗反应变异性和依从性的影响，相关数据十分有限。本跨诊断分析的目的是研究苯二氮䓬类药物对广泛性焦虑症（GAD）或重度抑郁症（MDD）老年患者的治疗效果的影响。

方法

对两项抗抑郁药物治疗 GAD（依西酞普兰与安慰剂，2006-2009 年）或 MDD（文拉法辛开放性治疗，2009-2014 年）的临床试验的二次数据分析。参与者包括 640 名年龄在 60 岁及以上的符合 DSM-IV 定义的 GAD（n = 177）或 MDD（n = 463）患者。基线时收集了苯二氮䓬类药物数据。在 12 周内评估了依从性和治疗反应。分析了合并使用苯二氮䓬类药物是否与治疗反应、抗抑郁药物的依从性、脱落、抗抑郁药物的最终剂量以及与抗抑郁药物相关的不良反应报告有关。