Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.
School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
Int J Geriatr Psychiatry. 2021 Jul;36(7):1075-1084. doi: 10.1002/gps.5505. Epub 2021 Feb 18.
Antidepressant are commonly prescribed to persons with cognitive disorders to treat depressive and other neuropsychiatric symptoms despite the inconclusive evidence on their effectiveness on this indication. We studied whether recent hospitalisation was associated with antidepressant initiation in people with Alzheimer's disease (AD).
The register-based Finnish nationwide Medication use and Alzheimer's disease cohort includes community-dwelling persons diagnosed with AD during 2005-2011 in Finland (n = 70,718). This study was restricted to people who initiated antidepressant use after AD diagnosis and had no active cancer treatment and schizophrenia or bipolar disorder diagnoses. We performed a nested case-control study with antidepressant initiators as cases. A matched noninitiator (sex, age and AD duration), was identified for each initiator (15,360 matched pairs). Recent hospitalisation was defined as hospital discharge within the past 14 days of initiation.
Antidepressant initiators were four times more likely (adjusted odds ratio: 4.41, 95% confidence interval: 4.06-4.80) to have been hospitalised within the past 2 weeks before initiation (21.2%, n = 3250) than matched noninitiators (5.4%, n = 831) and the duration of hospital stay was significantly longer among initiators. Dementia was the most common main discharge diagnosis among both initiators (43.8%, n = 1423) and noninitiators (24.8%, n = 206).
Recent hospitalisation was strongly associated with antidepressant initiation in persons with AD. Further studies are needed to investigate whether this is due to neuropsychiatric symptoms leading to hospital admission, inpatient care triggering or worsening neuropsychiatric symptoms or other indications. Nonpharmacological treatments for neuropsychiatric symptoms should be prioritised and the threshold for prescribing antidepressants should be high.
尽管抗抑郁药在该适应证上的疗效尚无定论，但仍常被开给有认知障碍的患者，以治疗抑郁和其他神经精神症状。我们研究了近期住院是否与阿尔茨海默病（AD）患者开始使用抗抑郁药有关。
基于登记的芬兰全国性药物使用和阿尔茨海默病队列纳入了 2005 年至 2011 年期间在芬兰被诊断为 AD 的社区居住者（n=70718）。本研究仅纳入 AD 诊断后开始使用抗抑郁药且无癌症治疗及精神分裂症或双相情感障碍诊断的患者。我们对抗抑郁药使用者（病例）进行了嵌套病例对照研究。为每位使用者（15360 对匹配）匹配了一位未使用者（性别、年龄和 AD 持续时间相匹配）。近期住院定义为起始前 14 天内的出院。
与匹配的未使用者（21.2%，n=3250）相比，抗抑郁药使用者在起始前 2 周内住院的可能性高 4 倍（调整后的优势比：4.41，95%置信区间：4.06-4.80），且住院时间明显更长。在起始者（43.8%，n=1423）和未起始者（24.8%，n=206）中，痴呆是最常见的主要出院诊断。
近期住院与 AD 患者开始使用抗抑郁药密切相关。需要进一步研究以明确这是否是由于导致住院的神经精神症状、住院治疗触发或加重神经精神症状或其他适应证所致。应优先考虑针对神经精神症状的非药物治疗，且抗抑郁药处方的门槛应较高。
