精神科重度憂鬱症病患使用抗憂鬱劑之處方型態研究

本研究為一種回溯性研究，篩選民國92年10月至93年3月間於門診就醫資料，為某醫學中心重鬱症初診的病患，並由病歷回溯紀錄其民國91年7月1日至93年9月30日之用藥情況。符合本研究條件之病患共有888位病患，其中以女性病患數約為男性之2.2倍，在民國91-93年中，病患年齡有年輕化之趨勢。病患使用抗憂鬱劑之情形以selective serotonin reuptake inhibitors（SSRI）之paroxetine開方比率最高為45.0%。約有一半的病人於治療一個月內即停用起初使用之抗憂鬱劑，治療達4個月者只有23.0％，超過6個月者更少，只有20.7％。造成停藥原因中以病患未回診所佔比例最高，其次為藥物不良反應發生、病情未改善及其他原因。本研究中抗憂鬱劑之有效治療率平均為20.7%，其中bupropion組之有效治療率只有9.4%比率偏低（P<0.05）。於各抗憂鬱劑有效治療率分析比較中發現，paroxetine組不管在男性或女性，皆在老年組中表現有較高的有效治療率（P<0.05）。在本研究顯示如病患合併有焦慮症狀，在paroxetine組顯示其被選用機率較沒有焦慮症狀的病患高（P<0.05），但在fluoxetine組則無差異，paroxetine是SSRI類藥品中唯一Food and Drug Administration (FDA)有核准用在generalized anxiety disorder（GAD）者，而fluoxetine則無，fluoxetine組於病患是否合併焦慮症狀卻沒有統計上的意義，這是需要注意的地方。在本研究中發現trazodone組之治療劑量Defined Daily Dose（DDD）數是各6組抗憂鬱劑中最低者（0.267±0.158），但在停藥原因分析中，發現其有最低之不良反應發生率及有較高之病情未改善率，又發現trazodone組之有效治療率與其他抗憂鬱劑並無差異，因此建議醫師可於臨床上使用trazodone治療重鬱症時，得增加劑量，應可增加其有效治療率。

關鍵字

抗憂鬱劑；重度憂鬱症；處方型態

並列摘要

The study was to evaluate the prescribing patterns of antidepressants. Data were derived from the Psychiatric department in a medical center. The study included all new diagnosis outpatient users of antidepressants in the Psychiatric department in a medical center from October 1, 2003 to March 1, 2004. There were 888 patients in the research of the study. Paroxetine was the most used antidepressant(45%). About half patient stop the first antidepressant at the beginning to treat major depression, 23% of patients take the antidepressant longer than 4 months, and 20.7% longer than 6 months. The average of response rate is 20.7%, but bupropion was lower(9.4%,P<0.05). The old group of paroxetine had higher response rate among male or female. Paroxetine was the best studies selective serotonin reuptake inhibitor（SSRI） for generalized anxiety disorder（GAD） and the only SSRI to date approved by US Food and Drug Administration for this indication. In our study, the rate of utilization of paroxetine was higher in the group that patient had anxious disease at the same time. Otherwise it was different with fluoxetine. This was a noteworthy question. The prescribing dosage of trazodone was lower than the other antidepressants, the adverse drug reaction incidence was lowest and the ratio of refractory to treatment was highest. The response rate of trazodone and the other antidepressants were not difference. Advise the doctor to increase the dosage of trazodone.

並列關鍵字

major depression ； prescribing pattern ； antidepressant

參考文獻

1. Williams JW Jr , Mulrow CD, Cfiquette E, et al, A systematic review of newer pharmacotherapies for depression in adults:evidence report summary, Ann Intern Med 2000; 132:743-56.