Epidemiology and Applied Clinical Research Department, Division of Psychiatry, University College London (UCL), UK.
Department of Primary Care & Population Health, Institute of Epidemiology & Health, University College London (UCL), London, UK.
Br J Psychiatry. 2023 Mar;222(3):112-118. doi: 10.1192/bjp.2022.160.
Individuals with physical comorbidities and polypharmacy may be at higher risk of depression relapse, however, they are not included in the 'high risk of relapse' group for whom longer antidepressant treatment durations are recommended.
In individuals with comorbid depression and type 2 diabetes (T2DM), we aimed to investigate the association and interaction between depression relapse and (a) polypharmacy, (b) previous duration of antidepressant treatment.
This was a cohort study using primary care data from the UK Clinical Practice Research Datalink (CPRD) from years 2000 to 2018. We used Cox regression models with penalised B-splines to describe the association between restarting antidepressants and our two exposures.
We identified 48 001 individuals with comorbid depression and T2DM, who started and discontinued antidepressant treatment during follow-up. Within 1 year of antidepressant discontinuation, 35% of participants restarted treatment indicating depression relapse. As polypharmacy increased, the rate of restarting antidepressants increased until a maximum of 18 concurrent medications, where individuals were more than twice as likely to restart antidepressants (hazard ratio (HR) = 2.15, 95% CI 1.32-3.51). As the duration of previous antidepressant treatment increased, the rate of restarting antidepressants increased - individuals with a previous duration of ≥25 months were more than twice as likely to restart antidepressants than those who previously discontinued in <7 months (HR = 2.36, 95% CI 2.25-2.48). We found no interaction between polypharmacy and previous antidepressant duration.
Polypharmacy and longer durations of previous antidepressant treatment may be associated with depression relapse following the discontinuation of antidepressant treatment.
患有躯体合并症和多种药物治疗的个体可能有更高的抑郁复发风险，但他们并不属于推荐延长抗抑郁药物治疗时长的“高复发风险”人群。
在患有合并抑郁和 2 型糖尿病（T2DM）的个体中，我们旨在调查抑郁复发与（a）多种药物治疗、（b）既往抗抑郁药物治疗时长之间的关联和相互作用。
这是一项基于英国临床实践研究数据链（CPRD）的队列研究，时间范围为 2000 年至 2018 年。我们使用带惩罚 B 样条的 Cox 回归模型来描述重新开始抗抑郁药物治疗与我们的两个暴露因素之间的关联。
我们确定了 48001 名患有合并抑郁和 T2DM 的个体，他们在随访期间开始并停止了抗抑郁药物治疗。在抗抑郁药物停药后的 1 年内，35%的参与者重新开始治疗，表明出现了抑郁复发。随着多种药物治疗的增加，重新开始抗抑郁药物治疗的比例也随之增加，直到最多同时使用 18 种药物时，重新开始抗抑郁药物治疗的可能性增加了两倍以上（风险比（HR）=2.15，95%置信区间 1.32-3.51）。随着既往抗抑郁药物治疗时长的增加，重新开始抗抑郁药物治疗的比例也随之增加 - 与之前停药时间<7 个月的个体相比，之前治疗时长≥25 个月的个体重新开始抗抑郁药物治疗的可能性增加了两倍以上（HR=2.36，95%置信区间 2.25-2.48）。我们没有发现多种药物治疗和既往抗抑郁药物治疗时长之间存在交互作用。
多种药物治疗和更长时间的既往抗抑郁药物治疗可能与抗抑郁药物治疗停药后抑郁复发有关。
