研究背景：抗憂鬱藥物已證實可減輕憂鬱症狀，但對於是否可降低自殺行為仍有許多爭議。過去研究顯示病人服用抗憂鬱藥物初期或藥物劑量改變時有增加自殺機率之風險，但穩定服用藥物一段時間後，自殺機率是否下降還未證實。因此，希望透過本研究了解我國穩定使用抗憂鬱藥物病人之自殺風險。

研究目的：探討穩定使用抗憂鬱藥物病人持續使用與非持續使用之自殺風險。

研究方法：採用回溯性世代研究法，資料來源為衛生福利部1997至2013年之健保資料。研究對象為2000-2012年間新使用抗憂鬱藥物(ATC code: N05A)且被診斷為憂鬱症、穩定使用至少90天之病患。排除條件包含癌症、思覺失調症及雙極性疾患之病人。第一筆抗憂鬱藥物處方日期加90天為指標日期。指標日期後持續使用藥物者為持續組，停止使用藥物為非持續組。研究觀察終點為自殺意念、自殺死亡及一年觀察結束。分析穩定使用藥物之病患持續組與非持續組之自殺相對風險。

結果：本研究共收錄7,260位病患，平均年齡為46.1歲(SD: 18.1)，女性(59.2%)大於男性。最常使用抗憂鬱藥物以SSRI為主，依序為fluoxetine (18.1%)、sertraline (14.1%)、paroxetine (10.4%)、escitalopram (7.3%)。持續組自殺意念之發生率為5.75 /1000人年、非持續組為8.44/1000人年。以非持續組為對照組，依性別、年齡、共病與使用藥物校正後自殺相對風險為0.69; 95% CI, 0.32-1.50。

結論：研究結果顯示持續使用藥物的病人有較低之自殺機率。建議穩定使用抗憂鬱藥物之病人需持續使用以降低患者自殺率。

Antidepressants are the mainstay in treatment of patients with depression; however, their effects on reduction of suicide risk remain unclear.
The study aimed to compare the risk of suicidal attempts between patients with depression persisted to antidepressants vs non-persisted patients.
We used the Taiwan’s National Health Insurance Database (NHID) from 1997-2013 for the study. We included patients diagnosed with depression newly received antidepressants for at least 90 days. We considered persistent patients as those continuously used antidepressants after 90 days, otherwise non-persisted patients were defined as those who discontinued. We followed up patients for one year unless the occurrence of suicide and suicide attempts. We performed Poisson regression model with adjustment for patients’ age, sex, psychiatric conditions and medications to evaluate the risk of suicidal attempts between antidepressants persisted and non-persisted patients.
We found the incidence rate of suicide attempts was lower in persisted group (5.75 per 1000 person-year) compared to non-persistent group (8.44 per 1000 person-year) with adjusted hazard ratio of 0.69 (95% CI, 0.32-1.50).
The findings suggested that persisting to antidepressants may provide a favorable outcome of patients with depression in reduction of suicide risk.

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