各类抗抑郁药物引发的自杀行为无差异

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No Difference in Suicidal Acts Found for Antidepressant Types

各类抗抑郁药物引发的自杀行为无差异
  

1.    Jun Yan

Jun Yan
  

The study compared young patients taking different types of antidepressants and was not designed to measure relative risk of antidepressants versus no drug treatment.

本研究比较了服用不同类型抗抑郁药物的年轻患者。研究中没有设置不服用药物的组别以测量这两类组别的相对危险性（RP）。

The rate of attempted and completed suicide did not differ between pediatric patients who were started on selective serotonin-reuptake inhibitors (SSRIs) and those taking tricyclic antidepressants, a large observational study has shown.

一项大型观察研究显示，自杀未遂与自杀死亡的比率在开始服用选择性五羟色胺再摄取抑制剂（SSRIs）与三环类抗抑郁药物的儿科患者中没有差别。
  

All antidepressants are required by the Food and Drug Administration (FDA) to carry a boxed warning in their labels regarding an increased risk of suicidality, including suicidal thoughts and behaviors, for children and young adults up to age 24. This risk was initially reported in patients using paroxetine, but the FDA decided in 2004 to mandate the warning on suicidality for all antidepressants, including tricyclics.

美国食品药品管理局（FDA）要求所有的抗抑郁药物都要在标识上添加有关高自杀风险的黑框警告，内容涉及儿童及24岁及以下青少年的自杀观头和行为。这一风险最初是由服用帕罗西汀的患者父母报告的，但是FDA却决定在2004年强制所有抗抑郁药物添加自杀警告，包括三环类药物。

The study, published online in Pediatrics on April 12, indicates that the total rate of suicidal acts, including attempted and completed suicides, within one year of antidepressant initiation was not significantly different between 10- to 18-year-old patients who started on SSRIs and those who started on tricyclics.

这项研究刊登在4月12日的《小儿科》期刊上，指出涵盖自杀未遂与自杀死亡两方面的自杀行为的总发生率，在10-18岁服用抗抑郁药物不足1年者中，服用SSRIs和服用三环类抗抑郁药物的患者差别不明显。
  

Because attempted and completed suicides are rare events, a large population base is needed to conduct a meaningful risk analysis. The authors, led by Sebastian Schneeweiss, M.D., Sc.D., an associate professor of medicine at Harvard Medical School and vice chief of the Division of Pharmacoepidemiology and Pharmacoeconomics at the Brigham and Women's Hospital, examined provincial health care data on nearly 21,000 pediatric patients in British Columbia within a nine-year period between January 1, 1997, and December 31, 2005. All patients included in the analysis were diagnosed with depression and were taking an antidepressant at the time due to a suicide-related hospitalization.

由于自杀未遂与自杀死亡都是小概率事件，所以我们需要扩大人口基数进行有意义的风险分析。哈佛医学院副教授、布礼根医学中心（Brigham and Women’ hospital）药物流行学与药物精细学部副部长Sebastian Schneeweiss医学博士、理学博士领导的作者们审查了1997年1月至2005年12月31日为止长达九年的不列颠哥伦比亚省省级健康数据中的近21000名儿科患者的数据。分析中的所有患者都曾诊断为抑郁并且当时因防自杀监护住院治疗的缘故，正服用着抗抑郁药物。
  

Within the first year of using an antidepressant, 266 youths made attempts, and three died of suicide. The incidence was calculated at approximately 27 suicidal acts per 1,000 person-years. Suicide attempts and suicides were identified by ICD-9 and ICD-10 diagnostic codes.

在服用抗抑郁药物的第一个年头，266名年轻人企图自杀，3人自杀致死。计算出的发病率大约为27次自杀行为/1000人每年。自杀未遂与自杀死亡符合ICD（国际疾病分类）-9和ICD-10的诊断标准。
  

The authors found no statistically significant difference in the risk of suicidal acts between patients who started on SSRIs and those who started on tricyclics. Nor were there significant differences in the risk of suicidal acts within the SSRI drug class in the comparisons among citalopram, fluvoxamine, paroxetine, sertraline, and fluoxetine.

作者们发现在服用SSRIs的患者和服用三环类抗抑郁药物的患者之间未发现自杀风险上的显著差异。同样，这种自杀行为的风险差异也未表现在SSRIs类药物之间：西酞普兰、氟伏沙明、帕罗西汀、舍曲林和氟西汀。
  

The authors also found that most of the suicidal acts took place within the first six months after antidepressant initiation.

作者还发现大多数自杀行为在服用SSRI起效后的前六个月发生。
  

“The interpretation of these findings is limited by a number of methodological factors,” David Fassler, M.D., commented to Psychiatric News. For example, the authors evaluated only pediatric patients who were hospitalized as a result of attempted suicide or completed suicide, but “research has demonstrated that the majority of children and adolescents with suicidal ideation, self-harm, and even suicide attempts are never hospitalized,” he noted.

“这些研究成果的解释受到若干方法论因素的约束，”David Fassler医学博士在向《精神病学新闻》解释时说道。例如，作者仅仅评估了住院治疗的儿科患者作为自杀未遂或自杀死亡的结果，但是“研究证明绝大多数儿童和青少年伴有自杀构想、自残、甚至自杀未遂者都从未住过院，”他强调。
  

Fassler is a child and adolescent psychiatrist and a clinical professor of psychiatry at the University of Vermont College of Medicine. He is also the APA secretary/treasurer.

Fassler是儿科和青少年精神病学家兼维蒙大学医学院（Universityof Vermont College of Medicine）精神病学系临床教授。他也是美国精神病学协会（APA）财务秘书长（？）。
  

Fassler pointed out several other limitations of this study. The authors included patients with a diagnosis of depression but not anxiety disorders, although anxiety symptoms may have an impact on suicidal behaviors different from that of depression. Also, they did not take into consideration the changes in prescribing patterns before and after the regulatory warnings between 2003 and 2005, which have been highlighted in other studies. These factors “could easily have influenced the results in a variety of ways,” said Fassler.

Fassler指出该研究的其他几项限制。作者们仅仅考虑把符合抑郁诊断的患者纳入研究，而未考虑焦虑症。虽然焦虑症对自杀行为的影响不同于抑郁症。而且，他们也没有将考虑过2003年-2005年间在强制性警告发布前后开药模式上的变化。这在其他研究中都得到了明确指出。这些因素“可以很轻易地以诸多方式影响研究结果，”Fassler表示。
   

Despite the FDA warnings, the extent to which antidepressants may induce suicidal thoughts and behaviors is still not well established, especially among adolescents who are at high risk for suicidal behaviors without treatment because of an underlying mental illness. After the regulatory warnings were issued, epidemiologists saw a spike in youth suicide that may or may not be associated with decreased use of these medications (Psychiatric News, October 5, 2007; October 3, 2008).

尽管有FDA警告的影响，抗抑郁药物多大程度上可以引起自杀观念和自杀行为至今仍然不明，特别是针对没有经过治疗的有着高风险自杀行为的青少年，这是因为他们的精神疾病不曾明显表现。在强制性警告出台后，流行病学家发现青少年自杀凸现，这或可能与这些药物使用减少有关。（精神病学新闻，2007年10月5日，2008年10月3日）。
  

This current study does not answer the question of whether or how much antidepressants increase suicidal behaviors in children and adolescents, as the authors did not compare the incidence of suicide attempts and suicides in young people who were not treated with antidepressants with that of those who were treated with antidepressants, Fassler suggested. He hopes that future large-scale, longitudinal studies will fully address these issues, including the public-health consequences of the boxed warning.

Fassler表示，由于作者们未在接受治疗和未经治疗的抑郁的青少年之间比较自杀未遂和自杀的发病率，目前正在进行着的研究并未回答抗抑郁药物是否或多大量会后增加儿童及青少年的自杀行为。他希望将来大型纵向研究会彻底解决包括黑框警告造成的各种公共健康后果在内的问题。
  

The study was funded by the National Institute of Mental Health.

该研究得到美国国家精神卫生研究所大力资助。

无甚可说，PN的标题新闻，应该给予翻一下的特惠，但是好像标题新闻具有无聊性！
错误总还是有的。。。
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2# 砚谷墨清

般若白莲

自杀是错误的行为，逃避不能解决问题，只会让爱自己的人伤心，而且逃到另一个世界会更痛苦！