Judd L L, Akiskal H S
Department of Psychiatry, University of California at San Diego, La Jolla 92093-0603, USA.
Pharmacopsychiatry. 2000 Jan;33(1):3-7. doi: 10.1055/s-2000-7967.
Through the use of polysomnographic, epidemiologic, and prospective clinical follow-up studies, the authors document that the course of major depressive disorder (MDD) is expressed by fluctuating symptoms in which depressive subtypes included in official diagnostic systems do not represent discrete disorders, but are stages along a dimensional continuum of symptomatic severity. Depressive symptoms at the major, minor, dysthymic or otherwise sub-threshold levels are all integral components of the longitudinal clinical structure of MDD with each symptom level representing a different phase of illness intensity, activity and severity. Detailed analyses indicate that patients are symptomatic 60 % of the time, much of it at the minor, dysthymic or subthreshold level. The symptomatic phases of illness activity are interspersed sporadically with inactive phases, when patients are asymptomatic. These findings are pertinent to both clinical cohorts and community-based epidemiologic samples. Each level of depressive symptom severity is associated with significant psychosocial impairment; such impairment increases progressively with each stepwise increment in symptom severity. When patients are asymptomatic their psychosocial functioning returns to good or very good levels. Residual subthreshold symptoms in the course of MDD are associated with high risk for early episode relapse and a significantly more chronic course of illness. Asymptomatic recovery from MDD is associated with significant delays in episode relapse and recurrence and a more benign course of illness. We submit that, as in the case of chronic medical conditions, the goal of treating unipolar depressive illness should optimally be to return the patient to as asymptomatic a level as is feasible by all available therapeutic means.
通过多导睡眠图、流行病学和前瞻性临床随访研究，作者证明了重度抑郁症（MDD）的病程表现为症状波动，其中官方诊断系统中包含的抑郁亚型并非代表离散的疾病，而是症状严重程度维度连续体上的不同阶段。重度、轻度、恶劣心境或其他亚阈值水平的抑郁症状都是MDD纵向临床结构的组成部分，每个症状水平代表疾病强度、活动和严重程度的不同阶段。详细分析表明，患者60%的时间有症状，其中大部分处于轻度、恶劣心境或亚阈值水平。疾病活动的症状阶段偶尔穿插着无活动阶段，即患者无症状时。这些发现适用于临床队列和基于社区的流行病学样本。抑郁症状严重程度的每个水平都与显著的心理社会损害相关；随着症状严重程度的逐步增加，这种损害也会逐渐加重。当患者无症状时，他们的心理社会功能会恢复到良好或非常好的水平。MDD病程中的残留亚阈值症状与早期发作复发的高风险以及明显更慢性的病程相关。从MDD中无症状恢复与发作复发和再发的显著延迟以及更良性的病程相关。我们认为，就像慢性疾病一样，治疗单相抑郁疾病的最佳目标应该是通过所有可用的治疗手段，使患者尽可能恢复到无症状水平。
