Ranking antidepressants according to their acceptability (i.e. a combination of both efficacy and tolerability) in the general population may help choosing the best first-line medication. This study aimed to rank antidepressants according to the proportion of filled prescription sequences consistent with a continuation of the first treatment versus those consistent with a change. A first step was validating this measure as a proxy of acceptability by examining the association of these two kinds of sequences with levels of depressive symptoms. Among 64,467 individuals included in the French population-based Constances cohort, reimbursements of antidepressants from January 2009 to December 2015 were extracted from the French national health insurance system claims database. Depressive symptoms were measured at inclusion with the Center for Epidemiologic Studies-Depression scale (CES-D). Between January 2010 and December 2015, 6675 participants newly initiated an antidepressant (34.5% men, mean (SD) age: 48.3 (12.1) years). Among the subsample of participants included during the six-month period following treatment initiation, individuals with continuation sequences had lower levels of depressive symptoms than those with change sequences (mean (SE) CES-D score: 18.9 (0.8) versus 26.5 (2.1), p < 0.001). According to the continuation/change ratio observed over this six-month period in all participants, escitalopram ranked first, followed by sertraline, venlafaxine, citalopram, fluoxetine and paroxetine. In an independent replication sample representative of the French national population, the same six medications ranked first, with escitalopram remaining in first place. The proportion of filled prescription sequences consistent with a continuation versus a change of the first prescribed treatment may provide a widely available measure of antidepressant acceptability in community practice.

中文翻译：

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使用填充的处方序列将抗抑郁药根据其在一般人群中的接受度进行排名：Constances队列。

根据一般人群中抗抑郁药的可接受性（即疗效和耐受性的组合）对抗抑郁药进行排名可能有助于选择最佳的一线药物。这项研究的目的是根据与连续治疗相一致的处方药顺序与变化后的处方相符的比例对抗抑郁药进行排名。第一步是通过检查这两种序列与抑郁症状水平的关联来验证该措施是否可以接受。从法国国家健康保险系统的索赔数据库中提取了2009年1月至2015年12月抗抑郁药的报销额，这是法国以人口为基础的Constances队列中所包含的64,467个人中的一部分。抑郁症状是在流行病学研究中心的抑郁量表（CES-D）中进行测量的。在2010年1月至2015年12月期间，有6675名参与者新开始了抗抑郁药治疗（男性34.5％，平均（SD）年龄：48.3（12.1）岁）。在开始治疗后的六个月内包括的参与者子样本中，具有持续序列的个体的抑郁症状水平低于具有变化序列的个体（平均CES-D评分：18.9（0.8）对26.5（2.1） ，p <0.001）。根据在这六个月期间所有参与者中观察到的持续/变化比，依西酞普兰排名第一，其次是舍曲林，文拉法辛，西酞普兰，氟西汀和帕罗西汀。在代表法国国民的独立复制样本中，同样的六种药物排在第一位，依他普仑仍然排在第一位。与第一处方治疗的继续与改变相对应的填充处方序列的比例可以提供社区实践中抗抑郁药可接受性的广泛可用度量。