Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
J Clin Psychiatry. 2023 May 24;84(4):22m14705. doi: 10.4088/JCP.22m14705.
To determine whether use of medications with potential depressive symptom side effects is associated with a higher level of depressive symptoms in adults with antidepressant-treated major depressive disorder (MDD). The study was based on the 2013-2014, 2015-2016, and 2017-2018 National Health and Nutrition Examination Survey (NHANES)-a nationally representative cross-sectional survey of the US general population. In 885 adult participants from these NHANES cycles who reported receiving antidepressants for treatment of MDD, the association between the number of medications with potential depressive symptom side effects and the level of depressive symptoms was assessed. A majority (66.7%, n = 618) of the participants with antidepressant-treated MDD used at least 1 non-psychiatric medication with potential depressive symptom side effects, and 37.3% (n = 370) used more than 1 such medication. The number of medications with depressive symptom side effects was significantly associated with lower odds of no to minimal depressive symptoms, defined as a Patient Health Questionnaire-9 (PHQ-9) score < 5 (adjusted odds ratio [AOR] = 0.75, 95% confidence interval [CI] = 0.64-0.87, < .001), and higher odds of moderate to severe symptoms, defined as a PHQ-9 score ≥ 10 (AOR = 1.14, 95% CI = 1.004-1.29, = .044). No such associations were found for medications without potential depressive symptom side effects. Individuals treated for MDD frequently use non-psychiatric medications for comorbid medical conditions that are associated with an increased risk of depressive symptoms. In evaluating the response to antidepressant medication treatment, side effects of concomitantly used medications should be considered.
为了确定在接受抗抑郁药治疗的重性抑郁障碍（MDD）成年人中，使用具有潜在抑郁症状副作用的药物是否与更高水平的抑郁症状相关。该研究基于 2013-2014、2015-2016 和 2017-2018 年全国健康与营养调查（NHANES）——一项针对美国一般人群的全国代表性横断面调查。在这些 NHANES 周期中报告接受抗抑郁药治疗 MDD 的 885 名成年参与者中，评估了具有潜在抑郁症状副作用的药物数量与抑郁症状水平之间的关系。大多数（66.7%，n=618）接受抗抑郁药治疗 MDD 的参与者使用了至少 1 种具有潜在抑郁症状副作用的非精神科药物，37.3%（n=370）使用了超过 1 种此类药物。具有抑郁症状副作用的药物数量与无到轻度抑郁症状的可能性降低显著相关，定义为患者健康问卷-9（PHQ-9）评分<5（调整后的优势比[OR]为 0.75，95%置信区间[CI]为 0.64-0.87， <0.001），与中度至重度症状的可能性增加相关，定义为 PHQ-9 评分≥10（OR 为 1.14，95%CI 为 1.004-1.29， =0.044）。对于没有潜在抑郁症状副作用的药物，没有发现这种关联。接受 MDD 治疗的个体经常使用非精神科药物治疗合并的医疗状况，这些状况与抑郁症状风险增加相关。在评估抗抑郁药治疗反应时，应考虑同时使用药物的副作用。
