下一步抗抑郁药治疗对自杀念头的影响:来自VAST-D试验的发现
Sidney Zisook1,2, Christine Yu Moutier3, A John Rush4,5
1University of California San Diego, San Diego, CA, USA.
Psychological medicine
|October 20, 2023
概括
大型抑郁症 (MDD) 的下一步治疗方法可以减少大多数患者的自杀想法. 然而,需要保持警,因为有些人在治疗期间经历了自杀念头 (SI) 的恶化.
科学领域:
- 精神病学是一个精神病学.
- 临床心理学 临床心理学
- 药理学 药理学是指药理学的学科.
背景情况:
- 大型抑郁症 (MDD) 是自杀的重要危险因素.
- 有效的MDD治疗对于预防自杀至关重要.
- 许多患者在初始药物治疗失败后需要随后的"下一步"治疗,但它们对自杀念头的影响还没有得到充分研究.
研究的目的:
- 在基线调查与自杀念头 (SI) 和自杀尝试 (SA) 相关的因素.
- 在MDD的下一步治疗中探索当前SI的预测因素.
- 分析不同下一步治疗对自杀行为的疗效.
主要方法:
- 对VA增强和切换治疗抑郁症试验的二次分析.
- 随机选择的1522名参与者接受了三个下一步的治疗:切换到布罗 (S-BUP),与布罗结合 (C-BUP),或与阿里皮普拉 (A-ARI) 进行增强.
- 在12周治疗期间检查了终身SI/SA和当前SI的基线特征.
主要成果:
- 终身SI + SA患者具有不同的人口和临床特征,包括更高的童年逆境和更严重的抑郁症,但更有可能对下一步治疗做出反应.
- 整体IS患病率从基线46.5%下降到治疗结束时的21.1%.
- 治疗期间当前的SI与基线SI,较差的心理健康,较大的MDD严重程度/持续时间和特定治疗臂 (S-BUP或C-BUP与A-ARI) 有关.
结论:
- 下一步的药物治疗通常会减少MDD患者的SI.
- 大约20%的患者可能会出现出现或恶化的SI,需要持续监测.
- 治疗选择可能会影响MDD急性治疗期间SI的风险.
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