Department of Health Sciences, University of York, York, United Kingdom.
Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
JAMA Netw Open. 2023 Jul 3;6(7):e2323746. doi: 10.1001/jamanetworkopen.2023.23746.
Selective serotonin reuptake inhibitors (SSRIs) are a commonly prescribed medication class to treat a variety of mental disorders. However, adherence to SSRIs is low, and uncovering the reasons for discontinuation among SSRI users is an important first step to improving medication persistence.
To identify the reasons SSRIs are discontinued or changed, as reported by patients and caregivers in online drug reviews.
DESIGN, SETTING, AND PARTICIPANTS: This qualitative study used natural language processing and machine learning to extract mentions of changes in SSRI intake from 667 drug reviews posted on the online health forum WebMD from September 1, 2007, to August 31, 2021. The type of medication change, including discontinuation, switch to another medication, or dose change and the reason for the change were manually annotated. In each instance in which an adverse event was reported, the event was categorized using Medical Dictionary for Regulatory Activities primary system organ class (SOC) codes, and its relative frequency was compared with that in spontaneous reporting systems maintained by the US Food and Drug Administration and the UK Medicines and Healthcare Products Regulatory Agency.
Reasons for SSRI medication change as assessed using SOC codes.
In total, 667 reviews posted by 659 patients or caregivers (516 [78%] of patients were female; 410 [62%] 25-54 years of age) were identified that indicated a medication change: 335 posts indicated SSRI discontinuation, 188 posts indicated dose change, and 179 posts indicated switched medications. Most authors 625 (95%) were patients. The most common reason for medication discontinuation or switching was adverse events experienced, and the most common reason for dose change was titration. Both uptitration and downtitration were initiated by either a health care professional or patient. The most common adverse events were classified by SOC codes as psychiatric disorders, including insomnia, loss of libido, and anxiety. Compared with those in regulatory data, psychiatric adverse events, adverse events recorded by investigations (mostly weight gain) and adverse events associated with the reproductive system (mostly erectile dysfunction) were reported disproportionately more often.
This qualitative study of online drug reviews found that useful information was provided directly by patients or their caregivers regarding their medication behavior, specifically, information regarding SSRI treatment changes that may inform interventions to improve adherence. These findings suggest that these reported adverse events may be associated with SSRI persistence and that people may feel more inclined to report such events on social media than to clinicians or regulatory agencies.
选择性 5-羟色胺再摄取抑制剂（SSRIs）是一种常用于治疗各种精神障碍的常用药物类别。然而，SSRIs 的依从性较低，发现 SSRIs 用户停药的原因是提高药物持久性的重要第一步。
从在线健康论坛 WebMD 上发布的 667 份药物评论中，确定患者和护理人员报告的 SSRIs 停药或换药的原因。
设计、设置和参与者：这项定性研究使用自然语言处理和机器学习从 2007 年 9 月 1 日至 2021 年 8 月 31 日在线健康论坛 WebMD 上发布的 667 份药物评论中提取 SSRIs 摄入变化的提及。手动注释了药物变化的类型，包括停药、改用其他药物或剂量变化以及变化的原因。在报告不良事件的每一个实例中，使用医疗保健监管活动的主要系统器官类别 (SOC) 代码对事件进行分类，并将其相对频率与美国食品和药物管理局和英国药品和保健品监管机构维持的自发报告系统进行比较。
使用 SOC 代码评估的 SSRIs 药物更改的原因。
共确定了 667 份由 659 名患者或护理人员发布的评论（516 名患者中有 335 名[78%]为女性；410 名[62%]为 25-54 岁），表明药物发生了变化：335 份帖子表示 SSRIs 停药，188 份帖子表示剂量变化，179 份帖子表示改用药物。大多数作者（625 名[95%]）为患者。停药或换药的最常见原因是不良事件，剂量变化的最常见原因是滴定。无论是由医疗保健专业人员还是患者发起，都可以进行上调或下调。最常见的不良事件按 SOC 代码分类为精神障碍，包括失眠、性欲减退和焦虑。与监管数据相比，更多地报告了精神病学不良事件、记录的不良事件（主要是体重增加）和与生殖系统相关的不良事件（主要是勃起功能障碍）。
这项对在线药物评论的定性研究发现，患者或其护理人员直接提供了有关其药物行为的有用信息，特别是有关可能影响依从性的 SSRI 治疗变化的信息。这些发现表明，这些报告的不良事件可能与 SSRIs 的持续存在有关，并且人们可能更倾向于在社交媒体上报告此类事件，而不是向临床医生或监管机构报告。
