对抗治疗抑郁症的药理疗法的发展轨迹:一项纵向研究
Julia R DiBello1, Xiaomo Xiong2,3, Xinyue Liu1
1Merck & Co., Inc, Rahway, NJ, USA.
BMC psychiatry
|March 11, 2025
概括
耐治疗抑郁症 (TRD) 涉及患有重度抑郁症 (MDD) 的患者,未能接受多种治疗. 这项研究揭示了组合疗法和增强越来越多地使用,强调了TRD的个性化治疗方法.
科学领域:
- 精神病学是一个精神病学.
- 药理学 药理学是指药理学的学科.
- 医疗保健服务研究 医疗服务研究
背景情况:
- 大型抑郁症 (MDD) 影响全球数百万人,其中有一部分人经历了治疗耐药性 (TRD).
- TRD被定义为对两种或更多抗抑郁药治疗的不充分反应.
- 了解TRD的自然史和治疗模式对于改善患者的治疗结果至关重要.
研究的目的:
- 描述治疗耐药性抑郁症 (TRD) 的自然史.
- 确定TRD患者的当代治疗模式和轨迹.
- 为TRD的MDD患者制定个性化治疗策略提供信息.
主要方法:
- 使用链接索赔和电子健康记录 (EHR) 数据进行的回顾性纵向研究 (2017年1月-2021年10月).
- 纳入标准:患有MDD的成年人 (≥18岁),没有基线抗抑郁药的使用,以及MDD诊断后90天内的索引日期.
- TRD定义为在一线开始后两年内接受第三线抗抑郁药治疗;第二线和第三线治疗涉及切换,添加或增强.
主要成果:
- 从一个更大的MDD队列中识别了2,409名事件TRD患者.
- 到TRD的中位时间为11.5个月,中位期持续时间为10.8个月.
- 抗抑郁药单一治疗从91.0% (第一线) 降至39.4% (第三线),而组合治疗在第三线增加到55.6%. 最常见的是SSRI,而53.5%的TRD患者使用认知行为疗法.
结论:
- 对TRD的当代治疗越来越多地涉及组合疗法和增强策略.
- 治疗轨迹存在显著差异,受患者人口统计学和并发症的影响.
- 需要精准医学方法来根据个体患者的特征和TRD的疾病进展量身定制治疗.
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