Mirtazapine

*仅供医学专业人士阅读参考抑郁症是造成双相情感障碍（BD）患者发病和死亡的重要原因，抑郁发作导致的住院属于BD的严重后果。预防住院是BD治疗的主要治疗目标。抗抑郁药和情绪稳定剂联合使用，在BD治疗中可以起到维持作用，停用维持治疗可能导致躁狂或抑郁发作。预防抑郁复发的治疗需求更高，抑郁复发风险随时间逐渐增加。治疗指南通常建议使用抗抑郁药进行抑郁阶段的急性管理，但并不建议其作为维持治疗。需要更多证据来确定抗抑郁药在BD治疗中的长期使用方案。来自瑞典哥德堡大学的研究团队讨论了使用抗抑郁药、抗精神病药和情绪稳定剂进行治疗，与BD患者住院之间的关系。研究包括10万余名BD患者，分析显示，与不使用抗抑郁药、抗精神病药和情绪稳定剂相比，仅使用抗抑郁药、仅使用抗精神病药、抗抑郁药和抗精神病药联合、抗精神病药和情绪稳定剂联合，都与抑郁相关住院风险升高有关，只有使用情绪稳定剂治疗与抑郁相关住院风险降低11%有关。对比不同药物单一疗法，只有锂盐单一治疗与抑郁相关住院风险降低25%有关。一些抗抑郁药甚至与抑郁相关住院风险增加有关。研究发表在Lancet Psychiatry杂志上。研究数据来自瑞典全国性队列，采用个体内分析方法，将每个参与者作为自身对照进行比较，减少个体差异相关的偏倚。研究包括诊断为BD的16至65岁个体，暴露因素包括抗抑郁药（舍曲林、米氮平、艾司西酞普兰、文拉法辛、西酞普兰、安非他酮、度洛西汀、氟西汀、阿米替林和沃替西汀）、抗精神病药（喹硫平、奥氮平、阿立哌唑和利培酮）和情绪稳定剂（拉莫三嗪、锂盐和丙戊酸），分别评估单药治疗和药物组合治疗。主要结果为抑郁发作导致的住院。次要结果是因躁狂发作或躯体化导致的住院。研究共纳入105495名BD患者，其中62.2%为女性，平均年龄44.2岁。平均随访时间为9.1年，16190人（15.3%）因抑郁发作至少住院一次，8066人（7.7%）因躁狂发作住院。随访期间，59963人（56.8%）接受过单一抗抑郁药治疗，47931人（45.4%）接受过单一情绪稳定剂治疗，46318人（43.9%）接受过抗抑郁药和情绪稳定剂联合治疗，有72201人（68.4%）经历过不使用药物治疗的时间。药物类型与抑郁相关住院风险的关系分析显示，与不使用药物治疗相比，使用抗抑郁药单一治疗、抗精神病药物单一治疗、抗抑郁药和抗精神病联合治疗都与抑郁相关住院风险增加有关，分别增加25%、39%和28%。只有情绪稳定剂单一治疗或抗抑郁药与情绪稳定剂联合治疗与抑郁相关住院风险降低有关，分别下降11%和8%。对具体药物进行分析，锂盐是唯一与抑郁相关住院风险降低有关的单一药物，与风险降低25%有关。在联合治疗方案中，锂盐与阿米替林、西酞普兰、文拉法辛联合使用，以及度洛西汀与拉莫三嗪联合使用，分别与抑郁相关住院风险降低51%、44%、38%和32%有关。一些单一药物治疗甚至与抑郁相关住院风险增加有关。不同药物与抑郁相关住院风险的关系没有发现抗抑郁药与抗精神病药的联合治疗方案，或情绪稳定剂与抗精神病药的联合治疗方案，与抑郁相关住院风险降低有关。在次要结果分析中，抗抑郁药治疗与躁狂相关住院风险增加22%有关，其他治疗方案与躁狂相关住院风险降低有关。锂盐与躯体化相关住院风险降低24%有关。总的来说，研究结果表明，仅使用抗抑郁药或抗精神病药与抑郁相关住院风险增加有关，而单独使用情绪稳定剂时，BD患者抑郁相关住院风险较低，锂盐是唯一与降低抑郁相关住院风险有关的单一药物，一些抗抑郁药与锂盐联合使用也可以取得比较好的治疗效果。同时，锂盐也是唯一对BD两种极端情绪都有益的单一治疗药物，有希望用作BD患者长期治疗的基础药物。Tips：想知道更多神经/精神疾病的最新相关内容，一定要来看看我们的重磅前沿《医学趋势30讲》～参考文献：Ermis C, Taipale H, Tanskanen A, et al. Real-world effectiveness of pharmacological maintenance treatment of bipolar depression: a within-subject analysis in a Swedish nationwide cohort. Lancet Psychiatry. Published online February 5, 2025. doi:10.1016/S2215-0366(24)00411-5本文作者丨王雪宁

TUESDAY, Feb. 25, 2025 (HealthDay news) -- Antidepressants are frequently prescribed to people with dementia for symptoms like anxiety, depression, aggressiveness and sleeplessness. But a specific class of antidepressant medications -- selective serotonin reuptake inhibitors (SSRIs) -- actually might speed up brain decline among some dementia patients, a new Swedish study suggests. Heavier doses of certain SSRIs are tied to a higher risk for severe dementia, researchers reported in a new study published Feb. 24 in the journal BMC Medicine . Taking more than the average amount typically prescribed for these drugs was linked to an additional decline of 0.42 points per year in a dementia scale that runs from 0 to 30, researchers found. The SSRI drug escitalopram was associated with the fastest cognitive decline, followed by citalopram and sertraline . Mirtazapine , which works in a different way, had less negative impact on brain function, researchers found. “Depressive symptoms can both worsen cognitive decline and impair quality of life, so it is important to treat them,” said senior investigator Sara Garcia Ptacek , an assistant professor of neurology at the Karolinska Institute in Solna, Sweden. “Our results can help doctors and other healthcare professionals choose antidepressants that are better adapted for patients with dementia,” she added in a news release. For the study, researchers tracked the brain health of more than 18,700 patients enlisted in the Swedish Registry for Cognitive/Dementia Disorders between May 2007 and Oct. 2018. The patients’ average age was 78. During an average follow-up of more than four years, about 23% of patients received a new prescription for an antidepressant, researchers said. SSRIs were the most commonly prescribed antidepressant, amounting to 65% of all those prescriptions, the study says. “Higher dispensed doses of SSRIs were associated with higher risk for severe dementia, fractures, and all-cause mortality,” the researchers concluded. “These findings highlight the significance of careful and regular monitoring to assess the risks and benefits of different antidepressants use in patients with dementia.” Faster rates of brain decline were observed among men taking antidepressants compared to women, results also show. However, outside experts warn that caution should be exercised when interpreting these results. “There are some important limitations that should be considered,” Dr. Prasad Nishtala , a reader in life sciences with the University of Bath in the U.K., said in a news release. “One major issue is that the severity of depression in dementia patients wasn't fully accounted for, which has the potential to bias the results,” said Nishtala, who reviewed the findings. “Additionally, there may be a ‘channelling bias,’ meaning that certain antidepressants like citalopram and sertraline might have been more commonly prescribed to patients with severe dementia, which could also bias the results.” He added that the study suggests that SSRIs like citalopram and sertraline might also speed up cognitive decline. "However, it doesn’t explain how or why this happens at a biological level,” Nishtala added. “Because of these limitations, the study's findings should be interpreted with caution and ideally replicated using other real-world data sources.” Whatever your topic of interest, subscribe to our newsletters to get the best of Drugs.com in your inbox.