目標：世界衛生組織曾預測：到2020年時，雙極性情感疾病將會成為全球第八個重要的公共衛生問題。綜觀過去的研究，雙極性情感疾病鬱期患者合併使用抗憂鬱劑是否會增加轉變為躁期的風險，仍無定論。本研究目的分析與探討台灣地區雙極性情感疾病鬱期門診病患合併使用抗憂鬱劑是否會增加轉變為躁期之風險、以及相關影響因子之探討。
方法：本研究分析2005至2010年之「全民健康保險學術研究資料庫」百萬人承保抽樣歸人檔。雙極性情感疾病鬱期門診病患依據情緒穩定劑是否合併抗憂鬱劑分為兩組，進行一年的回溯性觀察研究與分析，比較兩組的人口學特性、醫師特性和醫事機構特性有無差異。以Kaplan-Meier方法與Cox Proportional Hazard model探討有無使用抗憂鬱劑與鬱期轉變為躁期的影響因子。
結果：2005年至2010年共有420位雙極性情感疾病鬱期發作之門診患者進入研究觀察樣本且分為兩組（有無使用抗憂鬱劑）。沒有使用抗憂鬱劑組人數占26.7%，有使用抗憂鬱劑組人數占73.3%。有使用抗憂鬱劑組傾向在較年長或較資深的醫師門診看診。使用Kaplan-Meier方法與Log-Rank test檢定顯示：兩組（有無使用抗憂鬱劑）的存活曲線沒有統計上顯著的差異（p﹦0.569）。以Cox Proportional Hazard model調整性別、年齡、投保金額、投保類別、醫師年齡等變項後，使用抗憂鬱劑的hazard ratio為0.79，未達統計上的顯著性。
結論：本研究發現雙極性情感疾病鬱期門診患者合併使用抗憂鬱劑不會增加轉變為躁期的風險，與過去許多國外文獻研究結果一致。本研究可以成為醫師處理雙極性情感疾病鬱期門診病患合併抗憂鬱劑治療的參考，減輕鬱期對病患造成的社交與職業功能的損害，進一步減少國家的相關醫療保健支出。
Obiective: The World Health Organization estimates that by 2020, bipolar disorder will become one of the world’s top eight public health concerns. In the past literature findings, the combined use of antidepressants in bipolar depression patients can induce new episodes of precipitating hypomania or mania has been neither confirmed nor refuted by studies. This study discuss whether antidepressants use in bipolar depression outpatients increases the risk of precipitating mania or hypomania, as well as an analysis of the associated risk factors.
Method: The data employed in this study were randomly selected from the National Health Insurance Research Database between 2005 and 2010, which contains information on 1,000,000 individuals with health insurance. According to whether mood stabilizers were used alone or in combination with antidepressants in the treatment of bipolar depression, participants were placed into two study groups. A one-year retrospective review and analysis was carried out to identify any differences in demographics with respect to the medical professionals and treatment institutions between the two groups. The Kaplan-Meier method and Cox proportional hazards model were used to analyze whether the use of antidepressants had any association with the risk of precipitating hypomanic or manic episodes.
Results: Between 2005 and 2010 there were 420 bipolar out-patients presenting with their new episodes of depression; these were included in the study and further divided into two treatment groups (with or without antidepressants treatment).Patients who did not combine with antidepressants made up 26.7% of study population, and those that combined with antidepressants comprised the remaining 73.3%. In those who utilized antidepressants in their treatment tended to be managed by psychiatrists who were more elderly (p﹦0.095) or with greater clinical expertise (p﹦0.075). The Kaplan-Meier and Log-Rank tests revealed there was no significant difference in the survival curves of the two groups (p=0.569). Further analysis of gender, age, income bracket of policy holder, identification of policy holder and age of psychiatrist etc. were conducted with the Cox proportional hazards model and hazard ratios, and 95% confidence intervals were calculated. Hazard ratio of antidepressant use was 0.79 (CI 95%: 0.51-1.20) and did not reach significance.
Conclusion: The present study demonstrates that combination therapy (mood stabilizers and antidepressants) in bipolar depression out-patients does not increase the risk of precipitating hypomanic or manic states. This is consistent with the literature findings. The present study contributes to the therapeutic literature for psychiatrists managing depressive episodes in bipolar disorder patients, reducing the impairment of the patient’s social and occupational function, and thus reducing national healthcare-related medical expenditure.
