大うつ病性障害における治療開始までの期間と希死念慮との関連

Relationship between the Urge to Commit Suicide and the Period from Depression Onset to Treatment Initiation

抄録

　205人のうつ病患者において，症状出現から治療開始までの期間と，希死念慮との関係について検討した。調査は前方視研究で，薬物治療介入はfluvoxamineを主剤とした。結果は，治療開始までの期間と，治療開始8週間後の希死念慮の有無との間で有意差を認めた(p＜0.0001，オッズ比；222.2，95％CI；35.7～1,754.3)。さらに希死念慮消失率と治療開始までの期間を解析した結果，25週以上で希死念慮の消失率が急激に低下していた。なお，うつ病が寛解した患者全員で希死念慮が消失していた。症状出現から24週以内に治療を開始すること，うつ病を寛解までもっていくことが，希死念慮消失の重要な因子の1つと考えられた。

　In 205 patients with major depressive disorder, we analyzed the relationship between the time period before initiating therapy and the urge to commit suicide while carefully considering their depressive state. In this prospective study, we administered a single-agent (fluvoxamine) therapy. Logistic analysis showed significant differences in the urge to commit suicide after 8 weeks of treatment and the period from the onset to treatment initiation (p＜0.0001, odds rate；222.22, 95%CI；35.7～1,754.3). The urge to commit suicide decreased in groups in which treatment was initiated more than 25 weeks after the onset of depression. In addition, all the patients who recovered from depression no longer wanted to die. Further, patients in whom the depression remitted did not feel that their lives were worthless. Therefore, initiation of treatment within 24 weeks after the onset of depression and continuation of treatment untill the patients are cured were regarded as essential steps that can help get rid of the suicidal tendency.