Mittmann N, Herrmann N, Shulman K I, Silver I L, Busto U E, Borden E K, Naranjo C A, Shear N H
HOPE Research Centre, Division of Clinical Pharmacology, Sunnybrook Health Science Centre, University of Toronto, Ontario, Canada.
J Clin Psychiatry. 1999 Oct;60(10):690-7. doi: 10.4088/jcp.v60n1008.
This study examined the effectiveness of antidepressants in a group of elderly depressed outpatients by assessing depression prevalence and recording adverse events over time.
A prospective practice-based observational study (1991-1994) included consecutive outpatients at least 65 years of age with a DSM-III-R diagnosis of major affective disorder and who were prescribed antidepressant medications. Depressive symptoms were examined over time (stage 1 = 0 to 2 months; stage 2 = 2 to 6 months; stage 3 = 6 months to 2 years) with the Montgomery-Asberg Depression Rating Scale (MADRS). The cutoff scores of MADRS <18 and MADRS > or =18 were used in survival statistics. Adverse events were recorded systematically.
A total of 213 patients were seen over 2677 visits (mean +/- SD age = 75.5+/-6.1 years). MADRS scores for 85.8% of patients declined to below 18 within the first 2 months of antidepressant treatment. MADRS scores were above 18 for 37.3% of patients after 6 months and for 37.1% after 2 years. The mean time to decline in MADRS scores to below 18 in stage 1 was 36.1 days, and there was a significant difference between the antidepressant classes (log rank = 8.3, df = 3, p = .04), with tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs)/reversible inhibitors of monoamine oxidase A (RIMAs) having shorter times to response. The mean time to reach scores above cutoff during stage 2 was 144.3 days (log rank = 5.7, df = 3, p = .13) and during stage 3, 538.6 days (log rank = 9.8, df = 3, p = .02). Patients receiving TCAs and MAOIs/RIMAs had longer durations of MADRS scores below cutoff during stage 3 than those taking atypical antidepressants and selective serotonin reuptake inhibitors. All antidepressant classes reported similar adverse event profiles.
This study systematically examined antidepressant effectiveness in a prospective design. TCAs and MAOIs/RIMAs were shown to be superior in effectiveness during 2 of the 3 treatment stages.
本研究通过评估抑郁症患病率并长期记录不良事件，考察了抗抑郁药对一组老年门诊抑郁症患者的疗效。
一项基于实践的前瞻性观察性研究（1991 - 1994年）纳入了连续的年龄至少65岁、根据《精神疾病诊断与统计手册》第三版修订本（DSM - III - R）诊断为重度情感障碍且正在服用抗抑郁药的门诊患者。使用蒙哥马利 - 阿斯伯格抑郁评定量表（MADRS）对抑郁症状进行长期考察（第1阶段 = 0至2个月；第2阶段 = 2至6个月；第3阶段 = 6个月至2年）。在生存统计中使用MADRS <18和MADRS>或 = 18的临界值。系统记录不良事件。
共对213例患者进行了2677次访视（平均±标准差年龄 = 75.5±6.1岁）。85.8%的患者在抗抑郁治疗的前2个月内MADRS评分降至18分以下。6个月后，37.3%的患者MADRS评分高于18分，2年后这一比例为37.1%。第1阶段MADRS评分降至18分以下的平均时间为36.1天，不同抗抑郁药类别之间存在显著差异（对数秩检验 = 8.3，自由度 = 3，p = 0.04），三环类抗抑郁药（TCAs）和单胺氧化酶抑制剂（MAOIs）/单胺氧化酶A可逆抑制剂（RIMAs）的起效时间较短。第2阶段达到临界值以上评分的平均时间为144.3天（对数秩检验 = 5.7，自由度 = 3，p = 0.13），第3阶段为538.6天（对数秩检验 = 9.8，自由度 = 3，p = 0.02）。在第3阶段，接受TCAs和MAOIs/RIMAs治疗的患者MADRS评分低于临界值的持续时间比服用非典型抗抑郁药和选择性5 - 羟色胺再摄取抑制剂的患者更长。所有抗抑郁药类别报告的不良事件情况相似。
本研究以前瞻性设计系统考察了抗抑郁药的疗效。结果显示，在3个治疗阶段中的2个阶段，TCAs和MAOIs/RIMAs的疗效更佳。
