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Investigation of early and lifetime clinical features and comorbidities for the risk of developing treatment-resistant depression in a 13-year nationwide cohort study
BMC Psychiatry ( IF 4.4 ) Pub Date : 2020-11-17 , DOI: 10.1186/s12888-020-02935-z
Shiau-Shian Huang , Hsi-Han Chen , Jui Wang , Wei J. Chen , Hsi-Chung Chen , Po-Hsiu Kuo

To investigate the risk of treatment-resistant depression (TRD) in patients with depression by examining their clinical features, early prescription patterns, and early and lifetime comorbidities. In total, 31,422 depressive inpatients were followed-up from diagnostic onset for more than 10-years. Patients were diagnosed with TRD if their antidepressant treatment regimen was altered ≥two times or if they were admitted after at least two different antidepressant treatments. Multiple Cox regression model were used to determine whether physical and psychiatric comorbidities, psychosis, and prescription patterns increased the risk of TRD by controlling for relevant demographic covariates. Survival analyses were performed for important TRD-associated clinical variables. Females with depression (21.24%) were more likely to suffer from TRD than males (14.02%). Early anxiety disorders were more commonly observed in the TRD group than in the non-TRD group (81.48 vs. 58.96%, p < 0.0001). Lifetime anxiety disorders had the highest population attributable fraction (42.87%). Seventy percent of patients with multiple psychiatric comorbidities developed TRD during follow-up. Cox regression analysis further identified that functional gastrointestinal disorders significantly increased TRD risk (aHR = 1.19). Higher doses of antidepressants and benzodiazepines and Z drugs in the early course of major depressive disorder increased TRD risk (p < 0.0001). Our findings indicate the need to monitor early comorbidities and polypharmacy patterns in patients with depression associated with elevated TRD risk.

中文翻译:

在一项为期13年的全国队列研究中,调查了早期和终生的临床特征以及合并症对产生抗药性抑郁症的风险

通过检查抑郁症患者的临床特征,早期处方模式以及早期和终生合并症,调查其抗药性抑郁症(TRD)的风险。从诊断开始,总共对31,422名抑郁症住院患者进行了超过10年的随访。如果患者的抗抑郁治疗方案改变了两次以上,或者经过至少两次不同的抗抑郁治疗而被接受,则被诊断为TRD。通过控制相关的人口统计学协变量,使用多元Cox回归模型确定身体和精神疾病合并症,精神病和处方模式是否增加了TRD的风险。对与TRD相关的重要临床变量进行了生存分析。女性抑郁症(21.24%)比男性患TRD的可能性更大(14。02%)。TRD组比非TRD组更常见早期焦虑症(81.48 vs. 58.96%,p <0.0001)。终生焦虑症的人群归因分数最高(42.87%)。随访期间有多种精神病合并症的患者中有70%患有TRD。Cox回归分析进一步发现功能性胃肠道疾病显着增加了TRD风险(aHR = 1.19)。在重度抑郁症的早期,高剂量的抗抑郁药,苯并二氮杂and和Z药物会增加TRD风险(p <0.0001)。我们的研究结果表明,需要监测伴有TRD风险升高的抑郁症患者的早期合并症和多药模式。48比58.96%,p <0.0001)。终生焦虑症的人群归因分数最高(42.87%)。随访期间有多种精神病合并症的患者中有70%患有TRD。Cox回归分析进一步发现功能性胃肠道疾病显着增加了TRD风险(aHR = 1.19)。在重度抑郁症的早期,高剂量的抗抑郁药,苯并二氮杂and和Z药物会增加TRD风险(p <0.0001)。我们的研究结果表明,需要监测伴有TRD风险升高的抑郁症患者的早期合并症和多药模式。48比58.96%,p <0.0001)。终生焦虑症的人群归因分数最高(42.87%)。随访期间有多种精神病合并症的患者中有70%患有TRD。Cox回归分析进一步发现功能性胃肠道疾病显着增加了TRD风险(aHR = 1.19)。在重度抑郁症的早期,高剂量的抗抑郁药,苯并二氮杂and和Z药物会增加TRD风险(p <0.0001)。我们的研究结果表明,需要监测伴有TRD风险升高的抑郁症患者的早期合并症和多药模式。随访期间有多种精神病合并症的患者中有70%患有TRD。Cox回归分析进一步发现功能性胃肠道疾病显着增加了TRD风险(aHR = 1.19)。在重度抑郁症的早期,高剂量的抗抑郁药,苯并二氮杂and和Z药物会增加TRD风险(p <0.0001)。我们的研究结果表明,需要监测伴有TRD风险升高的抑郁症患者的早期合并症和多药模式。随访期间有多种精神病合并症的患者中有70%患有TRD。Cox回归分析进一步发现功能性胃肠道疾病显着增加了TRD风险(aHR = 1.19)。在重度抑郁症的早期,高剂量的抗抑郁药,苯并二氮杂and和Z药物会增加TRD风险(p <0.0001)。我们的研究结果表明,需要监测伴有TRD风险升高的抑郁症患者的早期合并症和多药模式。
更新日期:2020-11-17
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