Institute of Criminology and Legal Policy, University of Helsinki, Helsinki, Finland.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Addiction. 2022 Jan;117(1):234-242. doi: 10.1111/add.15625. Epub 2021 Jul 12.
Selective serotonin reuptake inhibitors (SSRIs) are widely prescribed medications for patients with anxiety/depression. These patients often have problems with substance use, but it remains unclear whether the risk of substance misuse is influenced by SSRI treatment. We aimed to determine whether SSRI treatment is associated with a decreased risk of acute substance misuse-related outcomes.
Cohort study following individuals through Swedish nation-wide registers between July 2005 and December 2013 and comparing the risk of substance misuse outcomes during periods on- versus off-treatment within the same individual.
Swedish general population.
Individuals with a newly dispensed prescription of SSRIs between July 2006 and December 2013 and an ICD-10 diagnosis of anxiety/depressive disorder before the first treatment initiation. The cohort included 146 114 individuals (60.7% women).
Substance misuse outcomes included ICD-10 diagnoses of acute intoxications (F10.0-F19.0), accidental poisonings by alcohol or drugs (X41-X42, X45-X46) and substance-related criminal offenses.
The absolute rate of substance misuse increased sharply before the onset of SSRI treatment and decreased after treatment initiation. Stratified Cox regression models showed an elevated risk [hazard ratio (HR) = 1.70, 95% confidence interval (CI) = 1.62-1.78] of substance misuse outcomes during a 1-month period preceding treatment initiation, compared with the reference period of more than 1 month before treatment start. The on-treatment estimates (1-30 days, HR = 1.29, 95% CI = 1.23-1.37; 31-120 days, HR = 1.30, 95% CI = 1.24-1.35; and > 120 days, HR = 1.24, 95% CI = 1.18-1.30 after treatment initiation] were consistently lower than the 1-month pre-treatment estimate, but still elevated compared with the reference period.
For people with anxiety/depression, the risk of substance misuse appears to be particularly elevated immediately before initiating selective serotonin reuptake inhibitor (SSRI) treatment, which may reflect the emergence or worsening of substance use problems concurrently with anxiety/depression. SSRI treatment appears to be associated with a lower risk of substance misuse compared with the 1-month period preceding treatment initiation, but causality remains uncertain.
选择性 5-羟色胺再摄取抑制剂（SSRIs）被广泛用于治疗焦虑/抑郁患者。这些患者常常存在物质使用问题，但目前尚不清楚 SSRI 治疗是否会影响物质滥用的风险。我们旨在确定 SSRI 治疗是否与急性物质滥用相关结局的风险降低有关。
对 2005 年 7 月至 2013 年 12 月期间通过瑞典全国登记处的个体进行队列研究，并比较同一个体中治疗期间和治疗期间前后物质滥用结局的风险。
瑞典一般人群。
2006 年 7 月至 2013 年 12 月期间首次开具 SSRIs 处方的个体，以及首次治疗开始前 ICD-10 诊断为焦虑/抑郁障碍的个体。队列包括 146114 人（60.7%为女性）。
物质滥用结局包括 ICD-10 诊断的急性中毒（F10.0-F19.0）、意外酒精或药物中毒（X41-X42、X45-X46）和与物质相关的犯罪行为。
在开始 SSRI 治疗之前，物质滥用的绝对发生率急剧上升，而在治疗开始后则下降。分层 Cox 回归模型显示，与治疗开始前超过 1 个月的参考期相比，治疗前 1 个月期间物质滥用结局的风险增加[危险比（HR）=1.70，95%置信区间（CI）=1.62-1.78]。治疗期间的估计值（1-30 天，HR=1.29，95%CI=1.23-1.37；31-120 天，HR=1.30，95%CI=1.24-1.35；治疗开始后>120 天，HR=1.24，95%CI=1.18-1.30）持续低于治疗前 1 个月的估计值，但仍高于参考期。
对于患有焦虑/抑郁的人，在开始选择性 5-羟色胺再摄取抑制剂（SSRI）治疗之前，物质滥用的风险似乎特别高，这可能反映了焦虑/抑郁同时出现或恶化的物质使用问题。与治疗前 1 个月相比，SSRI 治疗似乎与较低的物质滥用风险相关，但因果关系仍不确定。
