Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota, USA.
Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, USA.
J Womens Health (Larchmt). 2023 Nov;32(11):1229-1240. doi: 10.1089/jwh.2022.0484. Epub 2023 Oct 19.
Antidepressants are among the most prescribed medications in the United States. The aim of this study was to explore the prevalence of antidepressant prescriptions and investigate sex differences and age-sex interactions in adults enrolled in the Right Drug, Right Dose, Right Time: Using Genomic Data to Individualize Treatment (RIGHT) study. We conducted a retrospective analysis of the RIGHT study. Using electronic prescriptions, we assessed 12-month prevalence of antidepressant treatment. Sex differences and age-sex interactions were evaluated using multivariable logistic regression and flexible recursive smoothing splines. The sample consisted of 11,087 participants (60% women). Antidepressant prescription prevalence was 22.24% (27.96% women, 13.58% men). After adjusting for age and enrollment year, women had significantly greater odds of antidepressant prescription (odds ratio = 2.29; 95% confidence interval = 2.07, 2.54). Furthermore, selective serotonin reuptake inhibitors (SSRIs) had a significant age-sex interaction. While SSRI prescriptions in men showed a sustained decrease with age, there was no such decline for women until after reaching ∼50 years of age. There are important limitations to consider in this study. Electronic prescription data were cross-sectional; information on treatment duration or adherence was not collected; this cohort is not nationally representative; and enrollment occurred over a broad period, introducing confounding by changes in temporal prescribing practices. Underscored by the significant interaction between age and sex on odds of SSRI prescription, our results warrant age to be incorporated as a mediator when investigating sex differences in mental illness, especially mood disorders and their treatment.
抗抑郁药是美国最常开的处方药物之一。本研究旨在探讨抗抑郁药处方的流行情况，并研究参加“RIGHT”研究（正确的药物、正确的剂量、正确的时间：利用基因组数据实现个体化治疗）的成年人中的性别差异和年龄-性别交互作用。我们对 RIGHT 研究进行了回顾性分析。我们使用电子处方评估了 12 个月的抗抑郁治疗患病率。使用多变量逻辑回归和灵活递归平滑样条来评估性别差异和年龄-性别交互作用。该样本包括 11087 名参与者（60%为女性）。抗抑郁药处方的流行率为 22.24%（女性为 27.96%，男性为 13.58%）。在调整年龄和入组年份后，女性服用抗抑郁药的几率明显更高（优势比=2.29；95%置信区间=2.07，2.54）。此外，选择性 5-羟色胺再摄取抑制剂（SSRIs）存在显著的年龄-性别交互作用。虽然男性的 SSRIs 处方随着年龄的增长持续减少，但女性直到 50 岁左右才出现这种下降趋势。在这项研究中，有一些重要的局限性需要考虑。电子处方数据是横断面的；没有收集关于治疗持续时间或依从性的信息；本队列不具有全国代表性；并且入组时间跨度较大，引入了随时间推移处方实践变化的混杂因素。鉴于 SSRIs 处方的几率存在显著的年龄-性别交互作用，我们的研究结果表明，在研究精神疾病（尤其是情绪障碍及其治疗）中的性别差异时，年龄应作为中介纳入考虑。
