自從2004年,美國FDA公告服用抗憂鬱劑可能會增加自殺風險,因此常有網友在部落格會問我這個問題:到底有沒有安全的抗憂鬱劑,比較上自殺風險較低的選擇?
讓我們找出2010年,發表於權威期刊Archives of General Psychiatry《一般精神病學彙刊》的大規模統計的研究,該研究追蹤長達9年,分析對象多達287,543位年逾18歲的用藥者,分析發現,有846位出現自發行為(751位嘗試自殺,104位自殺成功),大部分的患者發生在開始用藥的前六個月。分析發現市面上經常被開立的選擇性血清素回收抑制劑,例如百憂解(學名為fluoxetine),克憂果(學名paroxetine ),樂復得(學名sertraline),舒憂膜(或者是安保喜樂膜衣錠,學名為citalopram)以及無鬱寧( 學名為fluvoxamine)等等,或者是選擇性血清素正腎上腺素回收抑制劑(例如千憂解、速悅這類藥物)甚至是傳統的三環抗憂鬱劑,其自殺風險都相當,並無差異。
相關研究原文擷取給大家參考:
Compared with selective serotonin reuptake inhibitors as a drug class, other classes including serotonin-norepinephrine reuptake inhibitors, tricyclic agents, and other newer and atypical agents had a similar risk.
Conclusions Our finding of equal event rates across antidepressant agents supports the US Food and Drug Administration's decision to treat all antidepressants alike in their advisory. Treatment decisions should be based on efficacy, and clinicians should be vigilant in monitoring after initiating therapy with any antidepressant agent.
因此,研究人員贊同FDA的公告警語,提醒憂鬱症患者服用抗憂鬱劑的前半年,應該留心是否出現自殺意念,甚至是自殺行為等等風險,相關研究可以參閱:
Sebastian Schneeweiss; Amanda R. Patrick; Daniel H. Solomon; Jyotsna Mehta; Colin Dormuth; Matthew Miller; Jennifer C. Lee; Philip S. Wang. Variation in the Risk of Suicide Attempts and Completed Suicides by Antidepressant Agent in Adults: A Propensity Score-Adjusted Analysis of 9 Years' Data. Archives of General Psychiatry, 2010; 67 (5): 497-506 [link]
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