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西雅图—团体健康精神病学家和研究员Greg Simon博士在社论中指出，由于个体对抗抑郁药物的反应不同，在最初治疗的几周内进行定期随访很重要。

Greg Simon的建议发表在《美国精神病杂志》第11期上，内容来源于最近几个有争议的研究，这些研究是关于儿童和青少年使用抗抑郁药物治疗导致自杀风险之间关系的研究。在目前缺乏证据的情况下，根据个人对抗抑郁药物反应不同，Greg Simon建议患者和治疗者在药物治疗的初期要保持密切联系。

Greg Simon的社论主要针对同一个杂志上Robert D. Gibbons博士和他同事的一篇文章，这篇文章报道了SSRI 抗抑郁药物的使用可以降低儿童和青少年自杀率，这一发现和最近另外2篇观察性研究的结果一致，但和其他研究数据是相矛盾的。

最近的研究数据表明，抗抑郁药物组和安慰剂对照组在自杀率上没有显著差异。这使这些证据变得更加复杂，抗抑郁治疗对自杀率的影响可能取决于药物和患者的个体差异，Greg Simon解释。由于操作这个类型的研究有困难，所以这些实验不能给出确切的答案。但是Greg Simon认为观察性研究为使用抗抑郁药提供了安全证据，例如，新型抗抑郁药物的使用和青少年自杀率降低是相伴随的。

最后，Greg Simon建议药物给与者要关注突然出现自杀想法和未接受药物治疗的抑郁症患者，并告知患者如下内容：

“食品药品监督管理局要求对抗抑郁药物做出通知，抗抑郁药物有时候能增加或引起自杀的想法。儿童和青少年的研究表明抗抑郁药物能增加自杀想法。但是，另外一些实验已经证明企图自杀的风险在开始使用抗抑郁药物后降低。即使大部分使用抗抑郁药物的患者症状得到改善，但仍有一些患者出现了负作用。因此，在用药最初几周定期随访非常重要。如果你有自杀或者是伤害自己的想法时，请立即与我联系。”

关于健康研究的团体健康中心

团体健康中心建立于1947年，是一所消费者管理、非营利性的健康保健系统。在西雅图，团体健康和他的辅助健康成分、团体健康选择、KPS健康计划服务于华盛顿和爱达荷的574000名成员。团体健康中心的健康研究涉及到主要疾病的预防、诊断和治疗。它主要由政府和私人科研补助金资助。

http://www.eurekalert.org/pub_releases/2006-11/ghcc-rfi103006.php

Regular follow-up important during antidepressant treatment
Editorial gives advice amidst conflicting studies on suicide
SEATTLE--Because individuals can react differently to antidepressant medications, regular follow-up is important during the first few weeks of treatment, according to an editorial by Group Health psychiatrist and researcher Greg Simon, MD, MPH.

Simon's advice, published in the November issue of the American Journal of Psychiatry, comes amidst several recent conflicting studies on the link between antidepressant use and suicide risk in children and adolescents. In the absence of clear evidence--along with proof that antidepressants' effects differ across individuals--Simon suggests that patients and providers stay well connected as drug therapy begins.

Simon's editorial was prompted by an article in the same journal by Robert D. Gibbons, PhD, and colleagues, reporting that counties with higher rates of SSRI antidepressant use had lower rates of suicide death in children and younger teens. While this finding is consistent with two other recent observational studies, it contradicts data from several other studies, Simon comments.

Also, data from recent studies in adults find no significant difference in suicide risk among those taking antidepressants compared to those taking a placebo. The issue is further complicated by recent evidence that effects on suicide risk may differ depending on the antidepressant and depending on the individual patient, explains Simon.

He states that additional studies cannot give a definitive answer to the question because of difficulties conducting this type of research. Still, he believes that observational research has provided "some reassurance." For example, increasing use of newer antidepressants has been accompanied by lower rates of suicide mortality in teens and adults.

Finally, he suggests that providers caught between concerns about precipitating a suicide attempt and concerns about untreated depression tell their patients this:

"The Food and Drug Administration requires a warning that antidepressant medications can sometimes cause or increase thoughts of suicide. Studies in children and adolescents have shown that antidepressants can increase suicidal thoughts. However, other studies have shown that the overall risk of attempting suicide goes down after starting antidepressant medication. Even if antidepressants help most people that take them, some people may have very negative reactions, Thus, it is important that we have regular contact over the next few weeks. If you have thoughts about suicide or about harming yourself, please contact me right away."

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