NCRR-The National Centre for Register-based Research, Aarhus University, Aarhus, Denmark.
NCRR-The National Centre for Register-based Research, Aarhus University, Aarhus, Denmark.
J Affect Disord. 2021 Jul 1;290:254-260. doi: 10.1016/j.jad.2021.04.045. Epub 2021 May 7.
Several national guidelines include recommendations for a minimum duration of antidepressant treatment, but these vary from 4-9 months after remission. We aimed to investigate whether there is an optimal minimum duration of antidepressant treatment to reduce relapse risk.
A Danish population-based cohort study among 89,442 adults who initiated antidepressants for depression treatment aged 18-60 years, from 2006-2015. We defined antidepressant discontinuation as ≥30 days without treatment. We estimated hazard ratios (HRs) with 95% confidence intervals (CIs) to indicate the risk of restarting antidepressants among those who discontinued antidepressants with <4, 4-6, and 7-9 months of use compared with discontinuation after 10-12 months.
For individuals on antidepressant treatment <4, 4-6, 7-9 and 10-12 months, cumulative incidence of restarting treatment within one year was 37.4% (95% CI: 36.9-37.8%), 35.1% (95% CI: 34.6-35.7%), 35.0% (95% CI: 34.2-35.8%) and 32.8% (95% CI: 31.7-34.0%), respectively. Individuals on antidepressants <10 months versus 10-12 months had higher risk of restarting antidepressants: the HR for antidepressant treatment <4 months was 1.21 (95% CI: 1.16-1.27), 4-6 months 1.11 (95% CI: 1.06-1.17), and 7-9 months 1.09 (95% CI: 1.04-1.15).
We were not able to ascertain the reasons why individuals discontinued antidepressants, and systematic errors from unmeasured confounders cannot be ruled out.
Based on our findings, a minimum of 10-12 months of treatment appears to be preferable if there is concern about relapse after discontinuation.
一些国家的指南包括对最低抗抑郁治疗持续时间的建议，但这些建议从缓解后 4-9 个月不等。我们旨在研究是否存在最佳的最低抗抑郁治疗持续时间，以降低复发风险。
这是一项丹麦基于人群的队列研究，纳入了 2006 年至 2015 年期间 89442 名年龄在 18-60 岁之间因抑郁症开始使用抗抑郁药治疗的成年人。我们将抗抑郁药停药定义为无治疗≥30 天。我们估计风险比（HR）及其 95%置信区间（CI），以表明与停药后 10-12 个月相比，停药后<4、4-6 和 7-9 个月使用抗抑郁药的患者重新开始使用抗抑郁药的风险。
对于<4、4-6、7-9 和 10-12 个月接受抗抑郁治疗的个体，一年内重新开始治疗的累积发生率分别为 37.4%（95%CI：36.9-37.8%）、35.1%（95%CI：34.6-35.7%）、35.0%（95%CI：34.2-35.8%）和 32.8%（95%CI：31.7-34.0%）。与 10-12 个月相比，<10 个月接受抗抑郁治疗的患者重新开始使用抗抑郁药的风险更高：<4 个月的抗抑郁治疗 HR 为 1.21（95%CI：1.16-1.27），4-6 个月为 1.11（95%CI：1.06-1.17），7-9 个月为 1.09（95%CI：1.04-1.15）。
我们无法确定个体停止抗抑郁治疗的原因，并且无法排除未测量混杂因素引起的系统误差。
根据我们的发现，如果担心停药后复发，至少 10-12 个月的治疗似乎是更好的选择。
