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首页> 外文期刊>The British journal of psychiatry : >Treatment-resistant and insufficiently treated depression and all-cause mortality following myocardial infarction
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Treatment-resistant and insufficiently treated depression and all-cause mortality following myocardial infarction

机译：难治性和未充分治疗的抑郁症以及心肌梗死后的全因死亡率

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Background:Depression is a known risk factor for mortality after an acute myocardial infarction. Patients with treatment-responsive depression may have a better prognosis than those with treatment-resistant depression.Aims:We sought to determine whether mortality following acute myocardial infarction was associated with treatment-resistant depression.Method:Follow-up began after myocardial infarction and continued until death or censorship. Depression was counted as present if diagnosed any time during the study period. Treatment for depression was defined as receipt of 12 or more weeks of continuous antidepressant therapy at a therapeutic dose during follow-up. Treatment-resistant depression was defined as use of two or more antidepressants plus augmentation therapy, receipt of electroconvulsive therapy or use of monoamine oxidase inhibitors. Mean duration of follow-up was 39 months.Results:During follow-up of 4037 patients with major depressivedisorder who had had a myocardial infarction, 6.9% of those with insufficiently treated depression, 2.4% of those with treated depression and 5.0% of those with treatment-resistant depression died. A multivariable survival model that adjusted for sociodemographics, anxiety disorders, beta-blocker use, mortality risk factors and health service utilisation indicated that compared with treated patients, insufficiently treated patients were 3.04 (95% Cl 2.12-4.35) times more likely and patients with treatment-resistant depression were 1.71 (95% Cl 1.05-2.79) times more likely to die.Conclusions:All-cause mortality following an acute myocardial infarction is greatest in patients with depression who are insufficiently treated and is a risk in patients with treatment-resistant depression. However, the risk of mortality associated with treatment-resistant depression is partly explained by comorbid disorders. Further studies are warranted to determine whether changes in depression independently predict all-cause mortality.
机译：背景：抑郁是急性心肌梗死后死亡的已知危险因素。目的：我们试图确定急性心肌梗死后的死亡率是否与难治性抑郁症有关。方法：随访患者是否为急性心肌梗死直至死亡或审查。如果在研究期间的任何时间被诊断为抑郁，则认为存在抑郁症。抑郁症的治疗定义为在随访期间以治疗剂量接受了12周或更长时间的连续抗抑郁治疗。难治性抑郁症定义为使用两种或多种抗抑郁药加增强疗法，接受电抽搐疗法或使用单胺氧化酶抑制剂。平均随访时间为39个月。结果：对4037例患有心肌梗塞的重度抑郁症患者进行随访，其中6.9％的抑郁症患者治疗不足，2.4％的抑郁症患者和5.0％的患者具有抗药性的抑郁症死亡。根据社会人口统计学，焦虑症，β-受体阻滞剂的使用，死亡率危险因素和卫生服务利用情况进行调整的多变量生存模型表明，与接受治疗的患者相比，接受治疗不足的患者患病的可能性是接受治疗的患者的3.04倍（95％Cl 2.12-4.35），难治性抑郁症死亡的可能性高1.71倍（95％Cl 1.05-2.79）倍。结论：急性心肌梗塞后全因死亡率在抑郁症患者中最大，这些患者治疗不足，并且有以下风险：抗抑郁症。但是，与抗药性抑郁症相关的死亡风险部分由合并症引起。有必要进行进一步的研究来确定抑郁症的变化是否能独立预测全因死亡率。

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