Cornelius Jack R, Clark Duncan B, Bukstein Oscar G, Kelly Thomas M, Salloum Ihsan M, Wood D Scott
Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara Street, PAARC Suite, Pittsburgh, PA 15213, USA.
Addict Behav. 2005 May;30(4):807-14. doi: 10.1016/j.addbeh.2004.08.025.
The goal of this 3-year follow-up evaluation was to determine whether the decreases in drinking and in depressive symptoms that were noted during our acute phase study with fluoxetine in comorbid adolescents persisted at a 3-year follow-up evaluation. At the 3-year follow-up evaluation, the group continued to demonstrate significantly fewer DSM criteria for an AUD and fewer BDI depressive symptoms and also consumed fewer standard drinks than they had demonstrated at the baseline of the acute phase study. However, 7 of the 10 participants demonstrated MDD at the 3-year follow-up assessment, and 4 demonstrated an AUD. The presence of a MDD was significantly correlated with the presence of an AUD at both the 1-year and the 3-year follow-up assessments. Four of the participants restarted SSRI medications during the follow-up period. Half of the subjects graduated from college during the 3-year assessment period, despite their residual depressive symptoms and drinking. We conclude that the long-term therapeutic effects of an acute phase trial of fluoxetine plus psychotherapy slowly decrease but did not disappear when fluoxetine is discontinued shortly after the acute phase trial. The high rate of MDD at follow-up suggests that longer term antidepressant medication treatment may be needed for at least some comorbid adolescents.
这项为期3年的随访评估的目的是确定，在我们对合并患有精神疾病的青少年使用氟西汀进行急性期研究期间所观察到的饮酒量及抑郁症状的减少，在3年随访评估时是否依然存在。在3年随访评估时，该组在酒精使用障碍（AUD）方面符合《精神疾病诊断与统计手册》（DSM）标准的情况及贝克抑郁量表（BDI）所显示的抑郁症状仍显著少于之前，并且其饮用的标准饮品数量也比急性期研究基线时有所减少。然而，10名参与者中有7名在3年随访评估时被诊断为重度抑郁障碍（MDD），4名被诊断为酒精使用障碍。在1年和3年随访评估中，重度抑郁障碍的存在与酒精使用障碍的存在均显著相关。4名参与者在随访期间重新开始服用选择性5-羟色胺再摄取抑制剂（SSRI）类药物。尽管存在残留的抑郁症状和饮酒问题，但在3年评估期内，有一半的受试者大学毕业。我们得出结论，氟西汀联合心理治疗的急性期试验的长期治疗效果会缓慢降低，但在急性期试验后不久停用氟西汀时，这种效果并未消失。随访时重度抑郁障碍的高发生率表明，至少对一些合并患有精神疾病的青少年而言，可能需要更长时间的抗抑郁药物治疗。
