Barge-Schaapveld Daniela Q C M, Nicolson Nancy A
Department of Psychiatry and Neuropsychology, Maastricht University, The Netherlands.
J Clin Psychiatry. 2002 Jun;63(6):477-85. doi: 10.4088/jcp.v63n0603.
Although some depression trials have included quality of life (QoL) as an outcome measure, assessments were retrospective and relatively infrequent. Because QoL varies in relation to everyday experience, intensive time-sampling approaches may be useful.
The experience sampling method (ESM) was used to assess effects of antidepressant treatment on the quality of life, as measured from moment to moment in daily life (mQoL), and related aspects of daily experience. Primary care patients with a DSM-III-R/DSM-IV diagnosis of major depressive disorder were randomly assigned to imipramine (N = 32) or placebo (N = 31) treatment for 6 weeks, with possible prolongation to 18 weeks. A healthy control group (N = 22) provided normative data.
Treatment-related increases in frequency and severity of physical complaints, including those not reported to the general practitioner as side effects, were associated with lowered mQoL; this negative association was especially strong in treatment dropouts. Despite greater clinical improvement at week 6, imipramine patients did not report greater increases than placebo patients in mean mQoL ratings. However, imipramine treatment stabilized mQoL fluctuations and led to reductions in time spent "doing nothing." Patients' decisions to prolong treatment depended on clinical improvement, mQoL changes, and specific early side effects. At 18 weeks, remitted patients still showed deficits on ESM daily life measures relative to healthy controls, even though QoL had returned to normal on retrospective measures.
ESM provides new insights in the effects of antidepressant treatment on daily life experiences and should therefore be considered as a supplement to conventional instruments in clinical trials.
尽管一些抑郁症试验已将生活质量（QoL）作为一项结果指标，但评估是回顾性的且相对不频繁。由于生活质量会因日常经历而有所不同，密集的时间抽样方法可能会有所帮助。
采用经验抽样法（ESM）来评估抗抑郁治疗对生活质量（从日常生活中的每时每刻来衡量，即瞬时生活质量[mQoL]）以及日常经历相关方面的影响。患有DSM-III-R/DSM-IV诊断的重度抑郁症的初级保健患者被随机分配接受丙咪嗪治疗（N = 32）或安慰剂治疗（N = 31），为期6周，可能延长至18周。一个健康对照组（N = 22）提供了规范性数据。
与治疗相关的身体不适频率和严重程度增加，包括那些未作为副作用向全科医生报告的不适，与较低的瞬时生活质量相关；这种负相关在治疗退出者中尤为强烈。尽管在第6周时临床改善更明显，但丙咪嗪治疗组患者在平均瞬时生活质量评分上的增加并不比安慰剂组患者更大。然而，丙咪嗪治疗稳定了瞬时生活质量的波动，并减少了“无所事事”的时间。患者延长治疗的决定取决于临床改善情况、瞬时生活质量变化以及特定的早期副作用。在18周时，缓解的患者在经验抽样法的日常生活测量中相对于健康对照组仍显示出缺陷，尽管回顾性测量显示生活质量已恢复正常。
经验抽样法为抗抑郁治疗对日常生活经历的影响提供了新的见解，因此在临床试验中应被视为对传统工具的补充。
