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首页> 外文期刊>The journal of clinical psychiatry >Antidepressants and risks of suicide and suicide attempts: a 27-year observational study.
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Antidepressants and risks of suicide and suicide attempts: a 27-year observational study.

机译：抗抑郁药和自杀及自杀未遂的风险：一项为期27年的观察性研究。

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OBJECTIVE: The 2007 revision of the black box warning for suicidality with antidepressants states that patients of all ages who initiate antidepressants should be monitored for clinical worsening or suicidality. The objective of this study was to examine the association of antidepressants with suicide attempts and with suicide deaths. METHOD: A longitudinal, observational study of mood disorders with prospective assessments for up to 27 years was conducted at 5 US academic medical centers. The study sample included 757 participants who enrolled from 1979 to 1981 during an episode of mania, depression, or schizoaffective disorder, each based on Research Diagnostic Criteria. Unlike randomized controlled clinical trials of antidepressants, the analyses included participants with psychiatric and other medical comorbidity and those receiving acute or maintenance therapy, polypharmacy, or no psychopharmacologic treatment at all. Over follow-up, these participants had 6,716 time periods that were classified as either exposed to an antidepressant or not exposed. Propensity score-adjusted mixed-effects survival analyses were used to examine risk of suicide attempt or suicide, the primary outcome. RESULTS: The propensity model showed that antidepressant therapy was significantly more likely when participants' symptom severity was greater (odds ratio [OR] = 1.16; 95% CI, 1.12-1.21; z = 8.22; P < .001) or when it was worsening (OR = 1.69; 95% CI, 1.50-1.89; z = 9.02; P < .001). Quintile-stratified, propensity-adjusted safety analyses using mixed-effects grouped-time survival models indicate that the risk of suicide attempts or suicides was reduced by 20% among participants taking antidepressants (hazard ratio, 0.80; 95% CI, 0.68-0.95; z = -2.54; P = .011). CONCLUSIONS: This longitudinal study of a broadly generalizable cohort found that, although those with more severe affective syndromes were more likely to initiate treatment, antidepressants were associated with a significant reduction in the risk of suicidal behavior. Nonetheless, we believe that clinicians must closely monitor patients when an antidepressant is initiated.
机译：目的：2007年修订的抗抑郁药自杀性黑匣子警告指出，应监测所有年龄段使用抗抑郁药的患者的临床恶化或自杀倾向。这项研究的目的是研究抗抑郁药与自杀未遂和自杀死亡的关系。方法：在美国5个学术医学中心进行了一项长达27年的前瞻性评估的纵向观察性情绪障碍研究。该研究样本包括757名参与者，他们从1979年至1981年在躁狂症，抑郁症或精神分裂性情感障碍发作期间入组，每人均基于研究诊断标准。与抗抑郁药的随机对照临床试验不同，分析的对象包括患有精神病和其他医学合并症的患者，以及接受急性或维持治疗，多药治疗或完全不接受心理药物治疗的患者。在随访中，这些参与者有6,716个时间段，被分类为暴露于抗抑郁药或未暴露于抗抑郁药。倾向得分调整后的混合效应生存分析用于检查自杀未遂或自杀（主要结局）的风险。结果：倾向模型显示，当参与者的症状严重程度更高（赔率[OR] = 1.16; 95％CI，1.12-1.21; z = 8.22; P <.001）时，抗抑郁治疗的可能性更大。恶化（OR = 1.69; 95％CI，1.50-1.89; z = 9.02; P <.001）。使用混合效应分组时间生存模型进行的五分位数分层，倾向性调整的安全性分析表明，服用抗抑郁药的参与者自杀未遂或自杀的风险降低了20％（危险比，0.80; 95％CI，0.68-0.95; z = -2.54; P = .011）。结论：这项对广泛可归纳的队列的纵向研究发现，尽管患有较严重情感综合症的人更有可能开始治疗，但抗抑郁药与自杀行为的风险显着降低有关。尽管如此，我们认为，抗抑郁药启动后，临床医生必须密切监视患者。

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