双相情感障碍以及锂盐、丙戊酸盐、喹硫平、奥氮平、文拉法辛和西酞普兰单药治疗的结果

Bipolar Disorder and Outcomes of Monotherapy with Lithium, Valproate, Quetiapine, Olanzapine, Venlafaxine, and Citalopram.

作者信息

Bohlken Jens, Riedel-Heller Steffi, Bauer Michael, Kostev Karel

机构信息

Institute for Social Medicine, Occupational Medicine, and Public Health (ISAP) of the Medical Faculty, University of Leipzig, Germany.

Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Medical Faculty, Technische Universität Dresden, Dresden, Germany.

出版信息

Pharmacopsychiatry. 2021 May;54(3):126-130. doi: 10.1055/a-1348-1523. Epub 2021 Jan 25.

DOI:10.1055/a-1348-1523

PMID:33494115

Abstract

INTRODUCTION

The aim of this study was to compare the outcomes of monotherapy in individuals with bipolar disorder who are prescribed lithium, valproate, quetiapine, olanzapine, venlafaxine, or citalopram in private psychiatric practices in Germany.

METHODS

This retrospective study included bipolar disorder patients who had initially started on a monotherapy with lithium, valproate, quetiapine, olanzapine, venlafaxine, or citalopram in 93 private neuropsychiatric practices in Germany between January 2006 and December 2017. Treatment failure was defined as time to discontinuation of medication or addition of another mood stabilizer, antipsychotic, antidepressant, or benzodiazepine.

RESULTS

A total of 4990 bipolar patients was examined for the period between 2006 and 2019. Initially, monotherapy with lithium (n=1.098), valproate (n=502), quetiapine (n=927), olanzapine (n=927), venlafaxine (n=574), or citalopram (n=962) was prescribed. Within 24 months, treatment failure had occurred in 76.3% (lithium), 85.1% (valproate), 84.6% (quetiapine), 85.2% (venlafaxine), 92.1% (olanzapine), and 86.6% (citalopram) of patients, respectively. The hazard ratio for treatment failure compared to lithium as reference was highest for olanzapine at 1.66 (1.46-1.88), followed by citalopram 1.27 (1.15-1.39), quetiapine 1.18 (1.07-1.29), valproate 1.18 (1.06-1.33), and venlafaxine 1.14 (1.02-1.27).

CONCLUSIONS

Our results underline the importance of lithium in the maintenance treatment of bipolar disorders.

摘要

引言

本研究的目的是比较在德国私人精神病诊所中，接受锂盐、丙戊酸盐、喹硫平、奥氮平、文拉法辛或西酞普兰单一疗法的双相情感障碍患者的治疗结果。

方法

这项回顾性研究纳入了2006年1月至2017年12月期间在德国93家私人神经精神病诊所最初开始接受锂盐、丙戊酸盐、喹硫平、奥氮平、文拉法辛或西酞普兰单一疗法的双相情感障碍患者。治疗失败定义为停药时间或加用另一种心境稳定剂、抗精神病药、抗抑郁药或苯二氮䓬类药物的时间。

结果

在2006年至2019年期间共检查了4990例双相情感障碍患者。最初，分别开具了锂盐（n = 1098）、丙戊酸盐（n = 502）、喹硫平（n = 927）、奥氮平（n = 927）、文拉法辛（n = 574）或西酞普兰（n = 962）的单一疗法处方。在24个月内，分别有76.3%（锂盐）、85.1%（丙戊酸盐）、84.6%（喹硫平）、85.2%（文拉法辛）、92.1%（奥氮平）和86.6%（西酞普兰）的患者出现治疗失败。以锂盐为对照，治疗失败的风险比最高的是奥氮平，为1.66（1.46 - 1.88），其次是西酞普兰1.27（1.15 - 1.39）、喹硫平（1.18（1.07 - 1.29）、丙戊酸盐1.18（1.06 - 1.33）和文拉法辛1.14（1.02 - 1.27）。