Bartova Lucie, Fugger Gernot, Dold Markus, Kautzky Alexander, Fanelli Giuseppe, Zanardi Raffaella, Albani Diego, Weidenauer Ana, Rujescu Dan, Souery Daniel, Mendlewicz Julien, Montgomery Stuart, Zohar Joseph, Fabbri Chiara, Serretti Alessandro, Kasper Siegfried
Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria.
Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria; Psychiatric Day Hospital University Hospital St. Poelten, Karl Landsteiner Private University of Health Sciences, Krems an der Donau, Austria.
J Affect Disord. 2023 Jul 1;332:105-114. doi: 10.1016/j.jad.2023.03.068. Epub 2023 Mar 22.
Serotonin-norepinephrine reuptake inhibitors (SNRIs) are among the most frequently prescribed antidepressants (ADs) for major depressive disorder (MDD), with an increasing trend in the last decade. Given the relative dearth of information regarding rationales for their preferred use as first-line ADs in the broad clinical routine, the present study systematically investigated real-world characteristics of MDD patients prescribed either SNRIs or other AD substances across different countries and treatment settings.
In the present secondary analyses based on a large European, multi-site, naturalistic and cross-sectional investigation with a retrospective assessment of treatment outcome, we firstly defined the proportion of MDD patients receiving SNRIs as first-line AD psychopharmacotherapy and secondly compared their sociodemographic and clinical characteristics to those patients prescribed alternative first-line ADs during their current major depressive episode (MDE).
Within the total sample of 1410 MDD patients, 336 (23.8 %) received first-line SNRIs. Compared to other ADs, SNRIs were significantly associated with inpatient care, suicidality and treatment resistance during the current MDE, and a longer lifetime duration of psychiatric hospitalizations. Moreover, greater severity of depressive symptoms at study entry, higher daily doses of the administered ADs, as well as more frequent prescriptions of psychopharmacotherapeutic add-on strategies in general and antipsychotic augmentation in particular, were significantly related to first-line SNRIs.
Considering the limitations of a cross-sectional and retrospective study design, our data point towards a preferred use of first-line SNRIs in a generally more severely ill MDD patients, although they did not lead to superior treatment outcomes compared to alternative ADs.
5-羟色胺-去甲肾上腺素再摄取抑制剂（SNRIs）是治疗重度抑郁症（MDD）时最常处方的抗抑郁药（ADs）之一，在过去十年中呈上升趋势。鉴于在广泛的临床实践中，关于将其作为一线抗抑郁药优先使用的理由的信息相对匮乏，本研究系统地调查了在不同国家和治疗环境中，开具SNRIs或其他抗抑郁药的MDD患者的真实世界特征。
在本次基于一项大型欧洲多中心、自然主义和横断面调查的二次分析中，对治疗结果进行回顾性评估，我们首先确定接受SNRIs作为一线抗抑郁心理药物治疗的MDD患者比例，其次将他们的社会人口统计学和临床特征与在当前重度抑郁发作（MDE）期间开具替代一线抗抑郁药的患者进行比较。
在1410例MDD患者的总样本中，336例（23.8%）接受一线SNRIs治疗。与其他抗抑郁药相比，SNRIs与当前MDE期间的住院治疗、自杀倾向和治疗抵抗显著相关，且精神科住院的终生时长更长。此外，研究入组时抑郁症状更严重、所服用抗抑郁药的每日剂量更高，以及一般而言心理药物附加治疗策略（尤其是抗精神病药物增效治疗）的处方更频繁，均与一线SNRIs显著相关。
考虑到横断面和回顾性研究设计的局限性，我们的数据表明一线SNRIs在病情通常更严重的MDD患者中更受青睐，尽管与替代抗抑郁药相比，它们并未带来更好的治疗效果。
