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首页> 外文期刊>CNS drugs >Antidepressant class, age, and the risk of deliberate self-harm: A propensity score matched cohort study of SSRI and SNRI users in the USA
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Antidepressant class, age, and the risk of deliberate self-harm: A propensity score matched cohort study of SSRI and SNRI users in the USA

机译：抗抑郁药的类别，年龄和故意自残的风险：一项针对美国SSRI和SNRI用户的倾向得分匹配队列研究

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Background: The US Food and Drug Administration's meta-analyses of placebo-controlled antidepressant trials found approximately twice the rate of suicidal behaviors among children and adults aged 24 years and younger who were randomized to receive antidepressant medication than among those who were randomized to placebo. Rates of suicidal behavior were similar for subjects aged 25-64 years whether they received antidepressants or placebo, and subjects aged 65 years or older randomized to antidepressants were found to have lower rates of suicidal behavior. The age-stratified FDA meta-analyses did not have adequate power to investigate rates of suicidal behaviors by antidepressant drug class. Objective: Our objective was to assess the risk of deliberate self-harm associated with the two most commonly prescribed classes of antidepressant agents. Design: Propensity score matched cohort study of incident users of antidepressant agents. Setting: Population-based healthcare utilization data of US residents. Patients: US residents aged 10-64 years with a recorded diagnosis of depression who initiated use of selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs) between 1 January 1998 and 31 December 2010. Main Outcome Measures: ICD-9 external cause of injury codes E950.x-E958.x (deliberate self-harm). Results: A total of 102,647 patients aged between 10 and 24 years, and 338,021 aged between 25 and 64 years, initiated therapy with antidepressants. Among 10-24 year olds, prior to propensity score matching, 75,675 initiated therapy with SSRIs and 5,344 initiated SNRIs. After matching, there were 5,344 SNRI users and 10,688 SSRI users. Among the older cohort, 36,037 SNRI users were matched to 72,028 SSRI users (from an unmatched cohort of 225,952 SSRI initiators). Regardless of age cohort, patients initiating SSRIs and patients initiating SNRIs had similar rates of deliberate self-harm. Restriction to patients with no antidepressant use in the past 3 years did not alter our findings. Conclusions: Our findings of similar rates of deliberate self-harm for depressed patients who initiate treatment with either an SSRI or an SNRI suggests that physicians who have decided that their patients would benefit from initiating antidepressant therapy need not weigh differential suicide risk when deciding which class of antidepressant to prescribe.
机译：背景：美国食品和药物管理局对安慰剂对照抗抑郁药试验的荟萃分析发现，随机接受抗抑郁药治疗的24岁及以下儿童和成年人中自杀行为的发生率约为随机接受安慰剂治疗者的两倍。无论是否接受抗抑郁药或安慰剂，年龄在25-64岁的受试者的自杀行为发生率相似，随机分配给抗抑郁药的65岁或65岁以上的受试者的自杀行为发生率较低。年龄分层的FDA荟萃分析没有足够的能力来研究按抗抑郁药类别划分的自杀行为发生率。目的：我们的目的是评估与两种最常用的抗抑郁药处方有关的故意自我伤害的风险。设计：倾向得分匹配的抗抑郁药物事件使用者的队列研究。设置：美国居民基于人口的医疗利用率数据。患者：1998年1月1日至2010年12月31日期间开始使用选择性5-羟色胺再摄取抑制剂（SSRIs）或5-羟色胺去甲肾上腺素再摄取抑制剂（SNRIs）的10-64岁美国居民，已确诊患有抑郁症。主要结果指标：ICD-9外部伤害原因代码为E950.x-E958.x（故意自我伤害）。结果：共有102,647名年龄在10至24岁之间的患者和338,021名年龄在25至64岁之间的患者开始了抗抑郁药治疗。在倾向评分匹配之前，在10至24岁的人群中，有75,675例SSRI起始疗法和5,344例SNRI起始疗法。匹配后，有5,344个SNRI用户和10,688个SSRI用户。在年龄较大的同类群组中，有360037个SNRI用户与72028个SSRI用户匹配（来自225952个SSRI发起者的不匹配队列）。不论年龄组，发起SSRI的患者和发起SNRI的患者的故意自残率相似。在过去3年中，限制不使用抗抑郁药的患者并没有改变我们的发现。结论：我们对SSRI或SNRI开始治疗的抑郁症患者故意故意伤害的发生率相似的发现表明，已决定其患者将从开始抗抑郁治疗中受益的医生在决定哪一类药物时无需权衡不同的自杀风险服用抗抑郁药。

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