Copenhagen Affective disorder Research Center (CADIC), Psychiatric Center Copenhagen, Copenhagen, Denmark.
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Acta Psychiatr Scand. 2024 May;149(5):378-388. doi: 10.1111/acps.13673. Epub 2024 Feb 20.
Long-term studies comparing nonresponse to antidepressants for major depressive disorder (MDD) are lacking.
To present systematic population-based nation-wide register data on comparative 2-year non-response within six antidepressant drug classes and 17 different antidepressants in patients with MDD.
The study included all 106,920 patients in Denmark with a first main index diagnosis of MDD at a psychiatric hospital inpatient or outpatient contact and who subsequently had a purchase of an antidepressant in the period from 1995 to 2018. Non-response to first antidepressant within a 2-year study period was defined as switch to or add-on of another antidepressant, antipsychotic medication, lithium, or hospitalization. Analyses emulated a targeted trial in populations standardized according to age, sex, socioeconomic status, and comorbidity with psychiatric and physical disorders.
Compared with sertraline, there was no difference for citalopram (RR: 1.00 [95% CI: 0.98-1.02]) but fluoxetine (1.13 [95% CI: 1.10-1.17]), paroxetine (1.06 [95% CI: 1.01-1.10]) and escitalopram (1.22 [95% CI: 1.18-1.25]) were associated with higher risk ratio of non-responses. Within selective noradrenaline reuptake inhibitors, sertraline outperformed reboxetine; within serotonin-norepinephrine reuptake inhibitors, venlafaxine outperformed duloxetine; within noradrenergic and specific serotonergic antidepressants, mirtazapine outperformed mianserin and within the class of other antidepressants, sertraline outperformed agomelatine and vortioxetine. Within tricyclic antidepressants, compared to amitriptyline, nortriptyline, dosulepin, and clomipramine had higher non-response, whereas there was no difference for imipramine.
These analyses emulating a randomized trial of "real world" observational register-based data show that 2-year long-term non-responses to some antidepressants within six different drug classes are increased over others.
缺乏比较抗抑郁药治疗重度抑郁症（MDD）无应答的长期研究。
本研究旨在基于人群的全国性登记数据，提供抗抑郁药六类药物和 17 种不同抗抑郁药治疗 MDD 患者 2 年无应答的系统比较。
该研究纳入了丹麦所有 106920 名首次在精神病医院住院或门诊诊断为 MDD 的患者，这些患者在 1995 年至 2018 年期间曾购买过一种抗抑郁药。2 年研究期间，首次抗抑郁药无应答的定义为改用或加用另一种抗抑郁药、抗精神病药物、锂或住院。分析模拟了根据年龄、性别、社会经济状况以及与精神和身体疾病的共病情况对人群进行标准化的靶向试验。
与舍曲林相比，西酞普兰（RR：1.00[95%CI：0.98-1.02]）、氟西汀（1.13[95%CI：1.10-1.17]）、帕罗西汀（1.06[95%CI：1.01-1.10]）和依他普仑（1.22[95%CI：1.18-1.25]）无应答风险比更高。在选择性去甲肾上腺素再摄取抑制剂中，舍曲林优于瑞波西汀；在 5-羟色胺-去甲肾上腺素再摄取抑制剂中，文拉法辛优于度洛西汀；在去甲肾上腺素和特异性 5-羟色胺能抗抑郁药中，米氮平优于米安色林；在其他抗抑郁药类别中，舍曲林优于阿戈美拉汀和沃替西汀。在三环类抗抑郁药中，与阿米替林相比，去甲替林、多塞平、氯米帕明的无应答率更高，而丙咪嗪则无差异。
这些模拟随机试验的“真实世界”观察性登记数据的分析表明，在六种不同药物类别中，一些抗抑郁药的 2 年长期无应答率高于其他药物。
