Papakostas George I, Petersen Timothy, Pava Joel, Masson Ella, Worthington John J, Alpert Jonathan E, Fava Maruizio, Nierenberg Andrew A
Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, WACC 812, 15 Parkman Street, Boston, Massachusetts, 02114, USA.
J Nerv Ment Dis. 2003 Jul;191(7):444-9. doi: 10.1097/01.NMD.0000081591.46444.97.
Depression and hopelessness are risk factors for suicide. The purpose of this study was to examine the extent of suicidal ideation and hopelessness in outpatients with treatment-resistant depression (TRD) and to study the impact of suicidal ideation and hopelessness on treatment with nortriptyline (NT). The degree of suicidal ideation and hopelessness was assessed during the screen visit with the use of items #3 and #30 of the Hamilton Depression Rating Scale (HAM-D) in 89 patients with TRD who entered a 6-week open trial of NT. Forty of these patients also completed the Beck Hopelessness Index (BHI) during the screen visit. In separate logistic regressions, the scores from the BHI and the two HAM-D items were then tested as predictors of clinical response to the 6-week trial with NT, controlling for the severity of depression. More than half of patients reported thoughts or wishes of death to self and significant hopelessness. A greater degree of hopelessness before treatment in completers, reflected by the score on the HAM-D item #30, predicted response to NT. More than half of patients with prominent hopelessness who completed the trial responded. Patients with TRD are more likely than not to report prominent suicidal ideation and hopelessness. Furthermore, a full 6-week trial of NT, a relatively noradrenergic tricyclic antidepressant, may be particularly useful in patients who have failed to respond to several antidepressants and also report significant hopelessness.
抑郁和绝望是自杀的风险因素。本研究的目的是调查难治性抑郁症（TRD）门诊患者的自杀意念和绝望程度，并研究自杀意念和绝望对去甲替林（NT）治疗的影响。在89例进入NT为期6周开放试验的TRD患者的筛查访视期间，使用汉密尔顿抑郁量表（HAM-D）的第3项和第30项评估自杀意念和绝望程度。其中40例患者在筛查访视期间还完成了贝克绝望指数（BHI）。在单独的逻辑回归分析中，将BHI得分以及HAM-D的两项得分作为NT为期6周试验临床反应的预测指标进行检验，并对抑郁严重程度进行控制。超过一半的患者报告有自我死亡的想法或愿望以及明显的绝望情绪。完成试验者治疗前更高程度的绝望情绪，由HAM-D第30项得分反映，可预测对NT的反应。完成试验的有明显绝望情绪的患者中，超过一半有反应。TRD患者很可能报告有明显的自杀意念和绝望情绪。此外，NT作为一种相对具有去甲肾上腺素能作用的三环类抗抑郁药，进行为期6周的完整试验，可能对几种抗抑郁药治疗无效且有明显绝望情绪的患者特别有用。
