Quitkin Frederic M, McGrath Patrick J, Stewart Jonathan W, Deliyannides Deborah, Taylor Bonnie P, Davies Carrie A, Klein Donald F
Department of Therapeutics, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, USA.
J Clin Psychiatry. 2005 Jun;66(6):670-6. doi: 10.4088/jcp.v66n0601.
This effectiveness study assessed remission rates in patients who had the opportunity to receive up to 3 antidepressant trials if unresponsive.
One hundred seventy-one consecutive outpatients entered 1 of 3 studies for the treatment of major depressive disorder (DSM-IV criteria) from January 1999 through December 2001. This group primarily received fluoxetine as a first treatment in trials lasting 6 to 12 weeks (a small number received gepirone). If unimproved, patients received a second or third trial (primarily clinician's choice). A standard criterion to determine remission-a score of 7 or less on the 17-item Hamilton Rating Scale for Depression-was used. In order to contrast remission rates with first-generation antidepressants, patients' outcomes in a previously published study that compared placebo, phenelzine, and imipramine were also examined (N = 420).
In an intent-to-treat analysis, 66% (113/171) of patients who were treated with second-generation antidepressants and 65% (275/420) of patients who were treated with first-generation antidepressants eventually achieved remission.
Remission rates in the effectiveness study are approximately 20% higher than the rates usually cited, a result of our choice to examine outcome following 3 treatment trials. This choice is dictated by good clinical practice. The usual procedure when comparing treatment modalities is to assess outcome after a single anti-depressant trial. The cumulative high remission rates suggest antidepressants are effective and should encourage more patients to seek treatment and physicians to develop techniques to improve patient adherence.
本疗效研究评估了那些若治疗无反应则有机会接受多达3次抗抑郁药物试验的患者的缓解率。
1999年1月至2001年12月期间，171名连续的门诊患者参加了3项治疗重度抑郁症（符合《精神疾病诊断与统计手册》第四版标准）研究中的1项。该组患者在为期6至12周的试验中主要接受氟西汀作为首次治疗（少数患者接受了吉哌隆）。若病情无改善，患者接受第二次或第三次试验（主要由临床医生选择）。采用标准的缓解判定标准——抑郁症状的17项汉密尔顿评定量表评分为7分或更低。为了将缓解率与第一代抗抑郁药物进行对比，还检查了先前一项比较安慰剂、苯乙肼和丙咪嗪的研究中患者的结果（N = 420）。
在意向性分析中，接受第二代抗抑郁药物治疗的患者中有66%（113/171）最终实现缓解，接受第一代抗抑郁药物治疗的患者中有65%（275/420）最终实现缓解。
疗效研究中的缓解率比通常引用的缓解率高出约20%，这是我们选择在3次治疗试验后检查结果的结果。这一选择是由良好的临床实践决定的。比较治疗方式时的常规程序是在单次抗抑郁药物试验后评估结果。累积的高缓解率表明抗抑郁药物是有效的，应鼓励更多患者寻求治疗，并鼓励医生开发提高患者依从性的技术。
