A Nationwide Target Trial Emulation Assessing the Risk of Antidepressant-Induced Mania Among Patients With Bipolar Depression.

IF 15.1 1区 医学 Q1 PSYCHIATRY
Christopher Rohde, Søren Dinesen Østergaard, Oskar Hougaard Jefsen
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引用次数: 0

Abstract

Objective: Antidepressants are commonly used to treat bipolar depression but may increase the risk of mania. The evidence from randomized controlled trials, however, is limited by short treatment durations, providing little evidence for the long-term risk of antidepressant-induced mania. The authors performed a target trial emulation to compare the risk of mania among individuals with bipolar depression treated or not treated with antidepressants over a 1-year period.

Methods: The authors emulated a target trial using observational data from nationwide Danish health registers. The study included 979 individuals with bipolar depression recently discharged from a psychiatric ward. Of these, 358 individuals received antidepressant treatment, and 621 did not. The occurrence of mania and bipolar depression over the following year was ascertained, and the intention-to-treat effect of antidepressants was analyzed by using Cox proportional hazards regression with adjustment for baseline covariates to emulate randomized open-label treatment allocation.

Results: The fully adjusted analyses revealed no statistically significant associations between treatment with an antidepressant and the risk of mania in the full sample (hazard rate ratio=1.08, 95% CI=0.72-1.61), in the subsample concomitantly treated with a mood-stabilizing agent (hazard rate ratio=1.16, 95% CI=0.63-2.13), and in the subsample not treated with a mood-stabilizing agent (hazard rate ratio=1.16, 95% CI=0.65-2.07). Secondary analyses revealed no statistically significant association between treatment with an antidepressant and bipolar depression recurrence.

Conclusions: These findings suggest that the risk of antidepressant-induced mania is negligible and call for further studies to optimize treatment strategies for individuals with bipolar depression.

评估双相抑郁症患者中抗抑郁药诱发躁狂症风险的全国性目标试验模拟。
目的:抗抑郁药是治疗双相抑郁症的常用药物,但可能会增加躁狂症的风险。然而,随机对照试验的证据因治疗时间较短而受到限制,因此几乎没有证据表明抗抑郁药诱发躁狂症的长期风险。作者进行了一项目标试验模拟,以比较双相抑郁症患者在一年内接受或未接受抗抑郁药治疗的躁狂症风险:作者利用丹麦全国健康登记册中的观察数据模拟了一项目标试验。研究对象包括 979 名刚从精神病院出院的双相抑郁症患者。其中,358 人接受了抗抑郁治疗,621 人未接受治疗。研究人员确定了躁狂症和双相抑郁症在随后一年中的发病情况,并采用考克斯比例危险回归分析了抗抑郁药物的意向治疗效果,同时对基线协变量进行了调整,以模拟随机开放标签治疗分配:完全调整后的分析显示,在全样本(危险比=1.08,95% CI=0.72-1.61)、同时接受情绪稳定剂治疗的子样本(危险比=1.16,95% CI=0.63-2.13)和未接受情绪稳定剂治疗的子样本(危险比=1.16,95% CI=0.65-2.07)中,抗抑郁剂治疗与躁狂症风险之间均无统计学意义。二次分析显示,抗抑郁药治疗与双相抑郁症复发之间没有统计学意义上的显著关联:这些研究结果表明,抗抑郁药诱发躁狂症的风险微乎其微,因此需要进一步研究,以优化双相抑郁症患者的治疗策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
American Journal of Psychiatry
American Journal of Psychiatry 医学-精神病学
CiteScore
22.30
自引率
2.80%
发文量
157
审稿时长
4-8 weeks
期刊介绍: The American Journal of Psychiatry, dedicated to keeping psychiatry vibrant and relevant, publishes the latest advances in the diagnosis and treatment of mental illness. The journal covers the full spectrum of issues related to mental health diagnoses and treatment, presenting original articles on new developments in diagnosis, treatment, neuroscience, and patient populations.
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