Perlis R H, Alpert J, Nierenberg A A, Mischoulon D, Yeung A, Rosenbaum J F, Fava M
Depression Clinical and Research Program, Massachusetts General Hospital, WACC 812, 15 Parkman Street, Boston, MA 02114, USA.
Acta Psychiatr Scand. 2003 Dec;108(6):432-8. doi: 10.1046/j.0001-690x.2003.00168.x.
Patients with major depressive disorder often show only partial or no response to antidepressants, necessitating next-step interventions such as dose increase or augmentation. Factors moderating response to these next-step interventions are not well-studied.
In this randomized, double-blind investigation of next-step treatments in 101 outpatients who failed to respond to fluoxetine 20 mg for 8 weeks, the impact of depressive course and sociodemographic factors on likelihood of treatment response following dose increase or lithium or desipramine augmentation was examined.
After controlling for depression severity at baseline, current marriage and earlier onset of depression were associated with greater likelihood of response in a logistic regression. Intervention strategy was not predictive of response.
Marital status and earlier onset of depression may be clinically useful in predicting outcome following any next-step intervention for treatment resistance, rather than with particular strategies.
重度抑郁症患者通常对抗抑郁药仅表现出部分反应或无反应，因此需要采取下一步干预措施，如增加剂量或联合用药。对这些下一步干预措施反应的调节因素尚未得到充分研究。
在这项针对101名对20毫克氟西汀治疗8周无反应的门诊患者进行的下一步治疗的随机双盲研究中，研究了抑郁病程和社会人口学因素对增加剂量或加用锂盐或去甲丙咪嗪后治疗反应可能性的影响。
在控制基线抑郁严重程度后，当前婚姻状况和较早的抑郁发作在逻辑回归中与更大的反应可能性相关。干预策略不能预测反应。
婚姻状况和较早的抑郁发作在临床上可能有助于预测对治疗抵抗的任何下一步干预后的结果，而不是特定的策略。
