全科医生对抗抑郁药物耐受性的看法：选择性5-羟色胺再摄取抑制剂与三环类抗抑郁药的比较

General practitioners' perceptions of the tolerability of antidepressant drugs: a comparison of selective serotonin reuptake inhibitors and tricyclic antidepressants.

作者信息

Martin R M, Hilton S R, Kerry S M, Richards N M

机构信息

Division of General Practice and Primary Care, St George's Hospital Medical School, London.

出版信息

BMJ. 1997 Mar 1;314(7081):646-51. doi: 10.1136/bmj.314.7081.646.

DOI:10.1136/bmj.314.7081.646

PMID:9066479

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2126112/

Abstract

OBJECTIVE

To examine inceptions and discontinuations of antidepressants in general practice.

DESIGN

An observational study analysing data from an ongoing cross sectional postal survey. Every three months a representative sample of 250 doctors recorded prescribing activity for four weeks. This provided 4000 general practitioner weeks of recording per year.

SETTING

A representative panel of general practitioners in England, Wales, and Scotland.

SUBJECTS

Patients who began a new course of an antidepressant or had their treatment stopped or changed by the general practitioner between 1 July 1990 and 30 June 1995.

MAIN OUTCOME MEASURES

Numbers of patients prescribed a new course of antidepressant; numbers discontinuing treatment; the ratio of antidepressant discontinuations to antidepressant inceptions; reasons for discontinuation; proportion of switches to another antidepressant.

RESULTS

There were 13,619 inceptions and 3934 discontinuations of selective serotonin reuptake inhibitors and tricyclic antidepressants during the study. The number of newly prescribed courses of antidepressants increased by 116%, mostly due to an increase in prescribing of serotonin reuptake inhibitors. The ratio of total discontinuations to inceptions was significantly lower for serotonin reuptake inhibitors (22%) than for tricyclic antidepressants (33%). Differences persisted when controlled for age and sex of patients and severity of depression. However, there was more switching away from selective serotonin reuptake inhibitors when they failed (72%) than from tricyclic antidepressants (58%).

CONCLUSIONS

Selective serotonin reuptake inhibitors are less likely than tricyclic antidepressants to be discontinued. A prospective study is needed in general practice to assess the implications of differences in discontinuation rates and switches on clinical and economic outcomes.

摘要

目的

在全科医疗中研究抗抑郁药的起始用药情况及停药情况。

设计

一项观察性研究，分析来自一项正在进行的横断面邮政调查的数据。每三个月，250名医生的代表性样本记录四周的处方活动。这每年提供4000个全科医生周的记录。

背景

英格兰、威尔士和苏格兰的全科医生代表性小组。

研究对象

1990年7月1日至1995年6月30日期间开始新的抗抑郁药疗程或被全科医生停止或改变治疗的患者。

主要观察指标

新开抗抑郁药疗程的患者数量；停药患者数量；抗抑郁药停药与起始用药的比例；停药原因；换用另一种抗抑郁药的比例。

结果

在研究期间，选择性5-羟色胺再摄取抑制剂和三环类抗抑郁药有13619例起始用药和3934例停药。新开抗抑郁药疗程的数量增加了116%，主要是由于5-羟色胺再摄取抑制剂处方量的增加。5-羟色胺再摄取抑制剂的总停药与起始用药比例（22%）显著低于三环类抗抑郁药（33%）。在对患者的年龄、性别和抑郁严重程度进行控制后，差异仍然存在。然而，当选择性5-羟色胺再摄取抑制剂治疗失败时，换药的比例（72%）高于三环类抗抑郁药（58%）。