Lampela Pasi, Tanskanen Antti, Lähteenvuo Markku, Tiihonen Jari, Taipale Heidi
Finnish Student Health Service, Helsinki, Finland.
School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
Acta Psychiatr Scand. 2024 Jan;149(1):41-51. doi: 10.1111/acps.13633. Epub 2023 Nov 20.
Antipsychotics (AP) have been used to augment antidepressant (AD) medication in treatment-resistant depression. In this study we examined factors (including severity of depression and initial antidepressant) affecting AP augmentation, as well as which APs were initiated as augmentation in young adults.
Data were extracted from Finnish nationwide registers. Of persons aged 18-29 years diagnosed with a depression during 2004-2017 we focused on incident AD users (who initiated AD 6 months before and after the diagnosis) whose severity level of depression was recorded (N = 21,966). AP augmentation was studied during 1 year after diagnosis of depression. Persons diagnosed with severe depression with psychotic features (n = 1486) were excluded from main analyses and analyzed separately.
Overall, 8.4% of new antidepressant users initiated AP augmentation. Risk of augmentation increased with severity of depression as 3.9%, 5.8%, and 14.0% of persons with mild, moderate, and severe depression, respectively, initiated augmentation. Male sex, comorbid anxiety and personality disorders, substance abuse and selfharm/suicide attempt were positively associated with augmentation. Compared to citalopram, use of tricyclic antidepressant, paroxetine and venlafaxine were associated with increased risk of augmentation, while use of bupropion was associated with a decreased risk. Quetiapine and risperidone were the most common APs used in augmentation. Among persons with severe depression with psychotic features, use of sertraline was associated with AP augmentation, whereas use of fluoxetine decreased risk of augmentation.
Use of APs as augmentation of AD therapy was common in severe depression. Comorbidities had only a small effect to augmentation, but selection of initial AD was more closely associated to risk of augmentation. Interestingly, use of bupropion decreased risk of augmentation, which warrants further studies, as well as the decrease in risk of augmentation when fluoxetine in case of psychotic depression was used.
抗精神病药物（AP）已被用于增强难治性抑郁症中抗抑郁药物（AD）的疗效。在本研究中，我们考察了影响AP增效治疗的因素（包括抑郁严重程度和初始抗抑郁药物），以及在年轻成年人中哪些AP被用作增效治疗。
数据从芬兰全国登记处提取。在2004年至2017年期间诊断为抑郁症的18至29岁人群中，我们重点关注了记录了抑郁严重程度的新发AD使用者（在诊断前后6个月开始使用AD）（N = 21966）。在抑郁症诊断后的1年内研究AP增效治疗情况。诊断为伴有精神病性特征的重度抑郁症患者（n = 1486）被排除在主要分析之外，并单独进行分析。
总体而言，8.4%的新抗抑郁药物使用者开始使用AP增效治疗。增效治疗的风险随着抑郁严重程度的增加而增加，轻度、中度和重度抑郁症患者中分别有3.9%、5.8%和14.0%的人开始增效治疗。男性、共病焦虑和人格障碍、药物滥用以及自残/自杀未遂与增效治疗呈正相关。与西酞普兰相比，使用三环类抗抑郁药、帕罗西汀和文拉法辛与增效治疗风险增加相关，而使用安非他酮与风险降低相关。喹硫平和利培酮是增效治疗中最常用的AP。在伴有精神病性特征的重度抑郁症患者中，使用舍曲林与AP增效治疗相关，而使用氟西汀则降低了增效治疗的风险。
在重度抑郁症中，使用AP增强AD治疗很常见。共病对增效治疗的影响较小，但初始AD的选择与增效治疗风险的相关性更强。有趣的是，使用安非他酮降低了增效治疗的风险，这值得进一步研究，以及在精神病性抑郁症中使用氟西汀时增效治疗风险的降低情况。
