Cook I A, Leuchter A F, Witte E, Abrams M, Uijtdehaage S H, Stubbeman W, Rosenberg-Thompson S, Anderson-Hanley C, Dunkin J J
Neuropsychiatric Institute/Hospital, Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, University of California, Los Angeles 90024-1759, USA.
Psychiatry Res. 1999 Mar 22;85(3):263-73. doi: 10.1016/s0165-1781(99)00010-4.
Treatment with antidepressants is marked by heterogeneity of response; predicting individual response to any given agent remains problematic. Neuroimaging studies suggest that response is accompanied by physiologic changes in cerebral energy utilization, but have not provided useful markers at pretreatment baseline. Using quantitative EEG (QEEG) techniques, we investigated pretreatment neurophysiologic features to identify responders and non-responders to fluoxetine. In a double-masked study, 24 adult subjects with current major depression of the unipolar type were studied over 8 weeks while receiving fluoxetine (20 mg QD) or placebo. Neurophysiology was assessed with QEEG cordance, a measure reflecting cerebral energy utilization. Response was determined with rating scales and clinical interview. Subjects were divided into discordant and concordant groups based upon the number of electrodes exhibiting discordance. The concordant group had a more robust response than the discordant group, judged by lower final Hamilton Depression (HAM-D) mean score (8.0+/-7.5 vs. 19.6+/-4.7, P = 0.01) and final Beck Depression Inventory (BDI) mean score (14.0+/-9.4 vs. 27.8+/-3.7, P = 0.015), and by faster reduction in symptoms (HAM-D: 14.0+/-5.0 vs. 23.8+/-4.1, P = 0.004 at 1 week). Groups did not differ on pretreatment clinical or historical features. Response to placebo was not predicted by this physiologic measure. We conclude that cordance distinguishes depressed adults who will respond to treatment with fluoxetine from those who will not. This measure detects a propensity to respond to fluoxetine and may indicate a more general responsiveness to antidepressants.
抗抑郁药治疗的特点是反应具有异质性；预测个体对任何一种特定药物的反应仍然存在问题。神经影像学研究表明，反应伴随着大脑能量利用的生理变化，但在治疗前基线时尚未提供有用的标志物。我们使用定量脑电图（QEEG）技术，研究治疗前的神经生理特征，以识别氟西汀的反应者和无反应者。在一项双盲研究中，对24名患有单相型当前重度抑郁症的成年受试者进行了为期8周的研究，期间他们接受氟西汀（每日20毫克）或安慰剂治疗。用QEEG协调性评估神经生理学，这是一种反映大脑能量利用的指标。通过评分量表和临床访谈确定反应情况。根据显示不一致的电极数量，将受试者分为不一致组和一致组。从最终较低的汉密尔顿抑郁量表（HAM-D）平均得分（8.0±7.5对19.6±4.7，P = 0.01）和最终贝克抑郁量表（BDI）平均得分（14.0±9.4对27.8±3.7，P = 0.015），以及症状更快减轻（HAM-D：1周时为14.0±5.0对23.8±4.1，P = 0.004）来看，一致组的反应比不一致组更强。两组在治疗前的临床或病史特征方面没有差异。这种生理指标无法预测对安慰剂的反应。我们得出结论，协调性可以区分出对氟西汀治疗有反应的抑郁症成年人和无反应的成年人。该指标检测到对氟西汀有反应的倾向，可能表明对抗抑郁药有更普遍的反应性。
