■抗抑郁药通常用于治疗双相抑郁,但可能会增加躁狂症的风险。随机对照试验的证据,然而,受治疗持续时间短的限制,几乎没有证据表明抗抑郁药引起的躁狂症的长期风险。作者进行了一项目标试验仿真,以比较在1年内接受或未接受抗抑郁药治疗的双相抑郁个体中躁狂症的风险。
■作者使用来自全国丹麦健康登记册的观察数据模拟了一项目标试验。该研究包括979名最近从精神科病房出院的双相抑郁症患者。其中,358人接受抗抑郁治疗,621没有。确定了第二年躁狂症和双相抑郁的发生,采用Cox比例风险回归分析抗抑郁药的意向治疗效果,并对基线协变量进行校正,以模拟随机开放标签治疗分配.
■完全调整的分析显示,在整个样本中,抗抑郁药治疗与躁狂症风险之间没有统计学上的显着关联(危险率比=1.08,95%CI=0.72-1.61),在伴随用情绪稳定剂治疗的子样本中(危险率比=1.16,95%CI=0.63-2.13),并且在未使用情绪稳定剂治疗的子样本中(危险率比=1.16,95%CI=0.65-2.07)。次要分析显示,抗抑郁药治疗与双相抑郁复发之间没有统计学上的显着关联。
■这些研究结果表明,抗抑郁药引起的躁狂症的风险可以忽略不计,需要进一步研究以优化双相抑郁症患者的治疗策略。
UNASSIGNED: Antidepressants are commonly used to treat bipolar depression but may increase the risk of
mania. The evidence from randomized controlled trials, however, is limited by short treatment durations, providing little evidence for the long-term risk of antidepressant-induced
mania. The authors performed a target trial emulation to compare the risk of
mania among individuals with bipolar depression treated or not treated with antidepressants over a 1-year period.
UNASSIGNED: The authors emulated a target trial using observational data from nationwide Danish health registers. The study included 979 individuals with bipolar depression recently discharged from a psychiatric ward. Of these, 358 individuals received antidepressant treatment, and 621 did not. The occurrence of mania and bipolar depression over the following year was ascertained, and the intention-to-treat effect of antidepressants was analyzed by using Cox proportional hazards regression with adjustment for baseline covariates to emulate randomized open-label treatment allocation.
UNASSIGNED: The fully adjusted analyses revealed no statistically significant associations between treatment with an antidepressant and the risk of
mania in the full sample (hazard rate ratio=1.08, 95% CI=0.72-1.61), in the subsample concomitantly treated with a mood-stabilizing agent (hazard rate ratio=1.16, 95% CI=0.63-2.13), and in the subsample not treated with a mood-stabilizing agent (hazard rate ratio=1.16, 95% CI=0.65-2.07). Secondary analyses revealed no statistically significant association between treatment with an antidepressant and bipolar depression recurrence.
UNASSIGNED: These findings suggest that the risk of antidepressant-induced
mania is negligible and call for further studies to optimize treatment strategies for individuals with bipolar depression.