抗精神病治疗和治疗耐药抑郁症患者的自杀风险:目标试验仿真框架研究
Daniel Hsiang-Te Tsai1,2, Avery Shuei-He Yang1,2, Zi-Xuan Wong1
1School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
概括
治疗耐药抑郁症的抗精神病药物增强并没有降低自杀风险和增加死亡率. 这些发现表明,抗精神病药物不应用于这种情况.
科学领域:
- 精神病学和药理学 精神病学和药理学
- 临床研究 临床研究
- 流行病学 流行病学
背景情况:
- 关于抑郁症增强疗法有效性的先前研究有限.
- 耐治疗抑郁症 (TRD) 构成了重大的临床挑战,需要探索新的治疗策略.
研究的目的:
- 评估抗精神病增强疗法在被诊断患有治疗耐药性抑郁症的患者中的疗效.
- 评估抗精神病药物增强对自杀相关结果和死亡率的影响.
主要方法:
- 一项回顾性队列研究包括39949名患有抑郁症的患者,他们在2009年至2020年期间接受了两次抗抑郁药疗程.
- 使用克隆-传感器-重量方法来缓解时间滞后偏差.
- 主要结局包括自杀企图和死亡,安全结局是心血管和全因死亡率.
主要成果:
- 最初的分析表明抗精神病药物减少了自杀企图,但在解决时间滞后偏差后,这种联系消失了.
- 随着抗精神病药物增强,没有观察到自杀死亡的显著减少.
- 抗精神病药物的使用与所有原因死亡率显著增加有关 (危险比1.21;95% CI1.07-1.33).
结论:
- 当考虑时间滞后偏差时,对TRD的抗精神病药物增强与自杀相关结果的风险降低无关.
- 观察到的全因死亡率的增加引发了严重的安全问题.
- 目前的证据不支持在治疗耐药性抑郁症患者中使用抗精神病增强剂.
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