Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Australia.
Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Australia; Melbourne Medical School, The University of Melbourne, Parkville, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
J Psychiatr Res. 2022 Oct;154:167-174. doi: 10.1016/j.jpsychires.2022.06.054. Epub 2022 Jul 20.
Evidence on therapeutic interventions and factors driving treatment intensification (TI) in people with incident depression in UK are scarce.
To explore antidepressant prescribing patterns and factors influencing TI.
and setting: Retrospective cohort study of adults with incident depression diagnosed between 2006 and 2017 using UK primary care database.
Patterns of antidepressant prescriptions, and factors influencing TI were evaluated by sex.
In 931,302 people with depression (90% initiating antidepressants), mean age was 39 years, 41% were male, 14% had cardiometabolic multimorbidity (CMM), and 54% were diagnosed at < 40 years. Being the most prescribed first-line antidepressant (62%), SSRI prescribing rate increased from 66 per 1000 person-years to 170 per 1000 person-years; 24% (2% dose escalation, 4% adding, 18% switching) of first-line antidepressant initiators intensified with 13 months median time to TI. Compared to 60-70 years, younger adults had significantly higher TI risk (range of hazards ratio, HR: 1.08-1.42). CMM and anxiety were associated with 15-24% and 39-49% significantly higher TI risks respectively. First-line antidepressant and deprivation status influenced TI differently by gender.
Men and women with depression in UK have different antidepressant prescription patterns in real-world. Age at diagnosis, deprivation status and cardiometabolic multimorbidity are the major sociodemographic and non-psychiatric risk factors for therapeutic changes.
英国在针对新发抑郁症患者的治疗干预措施和推动治疗强化（TI）的因素方面的证据有限。
探索抗抑郁药的处方模式以及影响 TI 的因素。
这是一项在英国初级保健数据库中使用的，针对 2006 年至 2017 年间新发抑郁症患者的回顾性队列研究。
评估了按性别划分的抗抑郁药处方模式和影响 TI 的因素。
在 931302 名患有抑郁症的患者（90%的患者开始服用抗抑郁药）中，平均年龄为 39 岁，41%为男性，14%患有心血管代谢性共病（CMM），54%的患者在 40 岁之前被诊断患有该疾病。SSRI 的处方率从每 1000 人年 66 例增加到每 1000 人年 170 例，作为最常被开的一线抗抑郁药（占 62%），有 24%（2%剂量增加，4%添加药物，18%更换药物）的一线抗抑郁药起始者进行了 TI，中位时间为 13 个月。与 60-70 岁相比，年轻患者的 TI 风险显著更高（范围为危害比，HR：1.08-1.42）。CMM 和焦虑症与 TI 风险分别增加 15-24%和 39-49%相关。一线抗抑郁药和贫困状况对 TI 的影响在不同性别之间存在差异。
英国新发抑郁症患者的抗抑郁药处方模式存在性别差异。诊断时的年龄、贫困状况和心血管代谢性共病是治疗变化的主要社会人口学和非精神性风险因素。
