背景:尽管可以使用具有不同作用机制的多种抗抑郁药(AD),在疗效和安全性方面没有显著差异.然而,很少有人尝试纳入不同AD下的主观经验数据。
方法:我们对网站www的帖子进行了定性和定量分析。askapatient.com从不同的AD。我们回顾了1000个帖子的随机样本。
结果:应用纳入和排除标准后,我们包含了450个帖子的最终样本,50在每个最常用的AD:舍曲林,西酞普兰,帕罗西汀,艾司西酞普兰,氟西汀,文拉法辛,度洛西汀,米氮平,还有安非他酮.安非他酮,西酞普兰,文拉法辛的总体满意度较高。舍曲林,帕罗西汀,氟西汀有很多情绪迟钝的报道,而安非他酮很少。对AD治疗的总体满意度与以下副作用的存在成反比:自杀,烦躁,情绪迟钝,认知障碍,和戒断症状。在调整了混杂因素后,只有情绪迟钝被证明是由血清素能药物的使用者更频繁地报告,与非血清素能药物相比。
结论:本研究指出,在选择AD时,应考虑接受治疗的患者的主观体验,因为药物之间的差异很明显。与更频繁的治疗决定相反,用户可能更喜欢接受非5-羟色胺能药物而不是5-羟色胺能药物,因为他们产生情绪迟钝的倾向较低。
Although a large variety of antidepressants agents (AD) with different mechanisms of action are available, no significant differences in efficacy and safety have been shown. However, there have been few attempts to incorporate data on subjective experiences under different AD.
We conducted a qualitative and quantitative analysis of the posts from the website www.askapatient.com from different AD. We reviewed a random sample of 1000 posts.
After applying the inclusion and exclusion criteria, we included a final sample of 450 posts, 50 on each of the most used AD: sertraline, citalopram, paroxetine, escitalopram, fluoxetine, venlafaxine, duloxetine, mirtazapine, and bupropion. Bupropion, citalopram, and venlafaxine had the higher overall satisfaction ratings. Sertraline, paroxetine, and fluoxetine had high reports of emotional blunting, while bupropion very few. Overall satisfaction with AD treatment was inversely associated with the presence of the following side-effects: suicidality, irritability, emotional blunting, cognitive disturbances, and withdrawal symptoms. After adjusting for confounders, only emotional blunting was shown to be more frequently reported by users of serotonergic agents, as compared to non-serotoninergic agents.
This research points out that the subjective experience of patients under treatment should be taken into consideration when selecting an AD as differences between agents were evident. In contrast to the more frequent treatment decisions, users might prefer receiving a non-serotoninergic agent over a serotonergic one due to their lower propensity to produce emotional blunting.