Weissman Cory R, Hadas Itay, Yu Dengdeng, Jones Brett, Kong Dehan, Mulsant Benoit H, Blumberger Daniel M, Daskalakis Zafiris J
Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
Neuropsychopharmacology. 2021 Jun;46(7):1293-1299. doi: 10.1038/s41386-020-00953-9. Epub 2021 Jan 21.
The effects of common antidepressants on suicidal ideation (SI) is unclear. In the landmark STARD trial antidepressants were effective for Major Depressive Disorder (MDD) in early treatment phases, but less effective in later phases. The effects of antidepressants on SI across the entire sample of the STARD trial has never been investigated. We performed a secondary analysis of the STAR*D data with the primary outcome of change in score on the suicide item (item three) of the Hamilton Rating Scale for Depression (HRSD) across all four study levels. We used descriptive statistics and logistic regression analyses. Pearson correlation was used for change in SI versus change in depression (HRSD). Reduction in mean (SD) SI was greater in levels one: 0.29 (±0.78) (p < 0.001) and two: 0.26 (±0.88) (p < 0.001) than in levels three: 0.16 (±0.92) (p = 0.005) and four: 0.18 (±0.93) (p = 0.094). A history of past suicide attempts (OR 1.72, p = 0.007), comorbid medical illness (OR 2.23, p = 0.005), and a family history of drug abuse (OR 1.69, p = 0.008) were correlated with worsening of SI across level one. Treatment with bupropion (OR 0.24, p < 0.001) or buspirone (OR 0.24, p = 0.001) were correlated with lowering of SI across level two. Improvement in SI was correlated with improvement in overall depression (HRSD) at level one: r(3756) = 0.48; level two: r(1027) = 0.38; level three: r(249) = 0.31; and level four: r(75) = 0.42 (p < 0.001 for all levels). Improvement in SI is limited with pharmacotherapy in patients with treatment-resistant depression. Treatments with known anti-suicidal effects in MDD, such as ECT, should be considered in these patients.
常用抗抑郁药对自杀观念（SI）的影响尚不清楚。在具有里程碑意义的STARD试验中，抗抑郁药在早期治疗阶段对重度抑郁症（MDD）有效，但在后期阶段效果较差。抗抑郁药对STARD试验整个样本中SI的影响从未被研究过。我们对STAR*D数据进行了二次分析，主要结局是汉密尔顿抑郁量表（HRSD）自杀项目（第3项）在所有四个研究阶段的得分变化。我们使用了描述性统计和逻辑回归分析。Pearson相关性用于SI变化与抑郁变化（HRSD）之间的分析。与第三阶段：0.16（±0.92）（p = 0.005）和第四阶段：0.18（±0.93）（p = 0.094）相比，第一阶段平均（标准差）SI降低幅度更大：0.29（±0.78）（p < 0.001）和第二阶段：0.26（±0.88）（p < 0.001）。既往自杀未遂史（比值比1.72，p = 0.007）、合并内科疾病（比值比2.23，p = 0.005）和药物滥用家族史（比值比1.69，p = 0.008）与第一阶段SI恶化相关。在第二阶段，使用安非他酮治疗（比值比0.24，p < 0.001）或丁螺环酮治疗（比值比0.24，p = 0.001）与SI降低相关。在第一阶段：r（3756）= 0.48；第二阶段：r（1027）= 0.38；第三阶段：r（249）= 0.31；第四阶段：r（75）= 0.42（所有阶段p < 0.001），SI改善与总体抑郁（HRSD）改善相关。对于难治性抑郁症患者，药物治疗对SI的改善有限。对于这些患者，应考虑采用在MDD中具有已知抗自杀作用的治疗方法，如电休克治疗（ECT）。
