抗抑郁剂治疗过程中双相抑郁患者自杀意念、自杀未遂的风险因素分析

Risk factors of antidepressant treatment emergent suicidal ideas or attempted suicide among patients with bipolar depression

目的 了解抗抑郁剂治疗过程中双相抑郁患者出现自杀意念、自杀未遂的风险因素.方法 623例双相障碍患者中筛选出68例初诊为＂单相抑郁＂而单用抗抑郁剂治疗的双相抑郁患者,根据半结构式访谈以及患者的病历资料对患者服药前后的自杀风险以及服药过程中出现的激活症状等进行评估,建立非条件Logistic回归方程对患者的抗抑郁剂治疗过程中的自杀风险进行因素分析.结果 68例患者中,7例（10.3%）在抗抑郁剂治疗过程出现自杀意念,4例（5.9%）出现自杀未遂,自杀意念或自杀未遂的出现时间在抗抑郁剂治疗后2～63d,平均（17.45±5.90）d.抗抑郁剂治疗过程中双相抑郁患者出现自杀意念或自杀未遂与服药前的自杀风险（P=0.012,OR=2.073）、是否合并苯二氮卓类药物（P=0.043,OR=0.236）有关,而与临床亚型、性别、年龄、症状特点、抗抑郁剂的种类以及用药过程中是否出现激活症状无关（P＞0.05）.结论 抗抑郁剂治疗过程中双相抑郁患者出现自杀意念、自杀未遂与服药前的自杀风险呈正相关,而与苯二氮卓类镇静催眠药的使用呈负相关.

Objective To explore the risk factors of antidepressant treatment emergent suicidal ideas or attempted suicide among patients with bipolar depression. Methods Out of 623 patients with bipolar disorder visiting between June 2006 and June 2009,68 who was initially diagnosed as unipolar disorder and treated with antidepressants were retrospectively surveyed. Suicide and activation symptoms during the process of antidepressant treatment were estimated based on the cases record and semi-structural interviews. Unconditional bivariate logistic regression was conducted to analyze the potential risk factors. Results Of 68 patients,7 （ 10. 3% ） experienced antidepressant treatment emergent suicidal ideas and 4 （ 5.9% ） attempted suicide after 2 to 63 （ 17.45 ± 5.90 ）days following the treatment. The antidepressant treatment emergent suicidal ideas or attempted suicide were related to the suicidal level before treatment （P= 0. 012, OR = 2. 072 ） and the combined use of benzodiazepine （P =0. 043, OR = 0.236）. Clinical subtypes, gender, age, symptoms feature, types of antidepressant and antidepressanttreatment emergent activation symptoms had little impact on the antidepressant treatment emergent suicidal ideas orattempted suicide （P ＞ 0.05 ）. Conclusion The antidepressant treatment emergent suicidal ideas or attempted suicide among patients with bipolar depression are positively related to the suicidal level before treatment while negatively associated with the combined use of benzodiazepine.