Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Psychiatry, General Cheng Hsin Hospital, Taipei, Taiwan.
Eur Neuropsychopharmacol. 2023 Sep;74:22-29. doi: 10.1016/j.euroneuro.2023.04.018. Epub 2023 May 28.
Studies have demonstrated a positive relationship between antidepressant resistance and the progression of bipolar disorder. However, the influence of antidepressant classes such as selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) in this context has yet to be investigated. A total of 5,285 adolescents and young adults with antidepressant-resistant depression and 21,140 with antidepressant-responsive depression were recruited in the present study. The antidepressant-resistant depression group was divided into two subgroups: only resistant to SSRIs (n = 2,242, 42.4%) and additionally resistant to non-SSRIs (n = 3,043, 57.6%) groups. The status of bipolar disorder progression was monitored from the date of depression diagnosis to the end of 2011. Patients with antidepressant-resistant depression were more likely to develop bipolar disorder during the follow-up (hazard ratio [HR]: 2.88, 95% confidence interval [CI]: 2.67-3.09) than those with antidepressant-responsive depression. Furthermore, the group that was additionally resistant to non-SSRIs were at the highest risk of bipolar disorder (HR: 3.02, 95% CI: 2.76-3.29), followed by the group that was only resistant to SSRIs (2.70, 2.44-2.98). Adolescents and young adults with antidepressant-resistant depression, especially those who responded poorly to both SSRIs and SNRIs, were at increased risk of subsequent bipolar disorder compared with those with antidepressant-responsive depression. Further studies are warranted to elucidate the molecular pathomechanisms underlying the resistance to SSRIs and SNRIs and subsequent bipolar disorder.
研究表明，抗抑郁药耐药与双相情感障碍的进展之间存在正相关关系。然而，在这种情况下，抗抑郁药类别（如选择性 5-羟色胺再摄取抑制剂 [SSRIs] 和 5-羟色胺去甲肾上腺素再摄取抑制剂 [SNRIs]）的影响尚未得到研究。本研究共招募了 5285 名抗抑郁药耐药性抑郁症和 21140 名抗抑郁药反应性抑郁症的青少年和年轻人。将抗抑郁药耐药性抑郁症组分为两个亚组：仅对 SSRIs 耐药（n=2242，42.4%）和对非 SSRIs 也耐药（n=3043，57.6%）组。从抑郁症诊断日期到 2011 年底监测双相情感障碍进展的状态。与抗抑郁药反应性抑郁症患者相比，抗抑郁药耐药性抑郁症患者在随访期间更有可能发展为双相情感障碍（风险比 [HR]：2.88，95%置信区间 [CI]：2.67-3.09）。此外，对非 SSRIs 也耐药的组发生双相情感障碍的风险最高（HR：3.02，95% CI：2.76-3.29），其次是仅对 SSRIs 耐药的组（2.70，2.44-2.98）。与抗抑郁药反应性抑郁症患者相比，抗抑郁药耐药性抑郁症患者，尤其是那些对 SSRIs 和 SNRIs 反应均不佳的患者，发生随后的双相情感障碍的风险增加。需要进一步研究来阐明 SSRIs 和 SNRIs 耐药和随后的双相情感障碍的分子发病机制。
