Supplementary data: A real-world analysis of antidepressant medications in US veterans aged 60 years and older: a comparative analysis

These are peer-reviewed supplementary materials for the article 'A real-world analysis of antidepressant medications in US veterans aged 60 years and older: a comparative analysis' published in the Journal of Comparative Effectiveness Research.
Table S1: Complete list of antidepressantsTable S2: Complete list of non-antidepressant augmentation drugsTable S3: Complete breakdown of baseline comorbiditiesTable S4: Outcomes by treatmentTable S5: Psychiatric hospitalization definitionTable S6: Average number of observation days in study for each treatment for each outcomeTable S7: Psychological hospitalization hazard ratios (reference = sertraline)Table S8: aHR for changing, augmenting, or hospitalization for patients with at least a 90-day observation period, right censored after 730 days (2 years)Aim: To compare the safety and efficacy of antidepressants (AD) among older adults with major depressive disorder (MDD) by assessing treatment change, augmentation and hospitalization rates. Methods: This retrospective study analyzed data from the Veterans Affairs (VA) database, including 142,138 patients aged ≥60 years diagnosed with MDD. Patients prescribed bupropion, citalopram, duloxetine, escitalopram, fluoxetine, mirtazapine, paroxetine, sertraline, or venlafaxine were included. Outcomes were treatment change, augmentation and hospitalization rates. Hazard ratios (aHRs) were calculated using sertraline as the reference. Results: Of the patients, 39.6% required augmentation, 18.1% changed antidepressant treatment and 13.3% were hospitalized. The corresponding incidence rate was 544, 124 and 122 events per 1000 person-years. Compared with sertraline, mirtazapine users had the highest AD change risk (aHR 1.34, 95% CI: 1.29–1.40), while duloxetine users had the lowest (aHR 0.87, 95% CI: 0.83–0.92). Duloxetine also had the lowest augmentation risk (aHR 0.89, 95% CI: 0.86–0.92). Mirtazapine users also had the highest risks of augmentation (aHR 1.15, 95% CI: 1.12–1.18) and hospitalization (aHR 1.14, 95% CI: 1.07–1.23). Bupropion had the lowest hospitalization risk (aHR 0.77, 95% CI: 0.71–0.84). Conclusion: Antidepressant choice significantly influences treatment outcomes in older adults with MDD. Duloxetine demonstrated the best profile with the lowest risks of AD change and augmentation, while mirtazapine posed the highest risks of all three outcomes. Personalized treatment strategies are crucial to improving outcomes in this population.

本材料为发表于《比较效果研究杂志》（Journal of Comparative Effectiveness Research）的论文《美国60岁及以上退伍军人抗抑郁药物真实世界分析：对比研究》的同行评议补充资料。
表S1：抗抑郁药物完整清单
表S2：非抗抑郁增效药物完整清单
表S3：基线共病情况详细分类
表S4：不同治疗方案的结局指标
表S5：精神科住院定义
表S6：研究中各结局指标下每种治疗方案的平均观察天数
表S7：精神科住院风险比（以舍曲林为参照）
表S8：针对至少具备90天观察期、且在730天（2年）后实施右删失的患者，其换药、增效治疗或住院的调整后风险比（adjusted hazard ratios, aHR）

研究目的：通过评估治疗换药、增效治疗及住院率，对比老年重度抑郁症（Major Depressive Disorder, MDD）患者所使用抗抑郁药（antidepressants, AD）的安全性与有效性。
研究方法：本回顾性研究分析了退伍军人事务部（Veterans Affairs, VA）数据库中的数据，共纳入142138名年龄≥60岁、确诊为重度抑郁症的患者。纳入标准为患者曾接受安非他酮、西酞普兰、度洛西汀、艾司西酞普兰、氟西汀、米氮平、帕罗西汀、舍曲林或文拉法辛治疗。本研究的结局指标包括治疗换药率、增效治疗率及住院率。以舍曲林作为参照组，计算调整后风险比（adjusted hazard ratios, aHRs）。
研究结果：全部患者中，39.6%需要接受增效治疗，18.1%更换了抗抑郁治疗方案，13.3%的患者发生住院事件。对应的事件发生率分别为每1000人年544例、124例及122例。与舍曲林相比，米氮平使用者的抗抑郁药换药风险最高（aHR=1.34, 95%CI: 1.29–1.40），度洛西汀使用者的换药风险最低（aHR=0.87, 95%CI: 0.83–0.92）。度洛西汀的增效治疗风险同样处于最低水平（aHR=0.89, 95%CI: 0.86–0.92）。米氮平使用者的增效治疗风险（aHR=1.15, 95%CI: 1.12–1.18）与住院风险（aHR=1.14, 95%CI: 1.07–1.23）均为所有药物中最高。安非他酮的住院风险最低（aHR=0.77, 95%CI: 0.71–0.84）。
研究结论：抗抑郁药物的选择对老年重度抑郁症患者的治疗结局具有显著影响。度洛西汀展现出最优的综合特征，其抗抑郁药换药及增效治疗风险最低，而米氮平在三项结局指标中均呈现最高风险。针对该人群制定个体化治疗策略，对改善治疗结局至关重要。