Driscoll Henry C, Basinski James, Mulsant Benoit H, Butters Meryl A, Dew Mary Amanda, Houck Patricia R, Mazumdar Sati, Miller Mark D, Pollock Bruce G, Stack Jacqueline A, Schlernitzauer Mary Ann, Reynolds Charles F
Intervention Research Center for Late-Life Mood Disorders, Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213, USA.
Int J Geriatr Psychiatry. 2005 Jul;20(7):661-7. doi: 10.1002/gps.1334.
To explore clinical and treatment-response variability in late-onset vs early-onset non-bipolar, non-psychotic major depression.
We grouped patients from a late-life depression treatment study according to illness-course characteristics: those with early-onset, recurrent depression (n = 59), late-onset, recurrent depression (n = 27), and late-onset, single-episode depression (n = 95). Early-onset was defined as having a first lifetime episode of major depression at age 59 or earlier; late-onset was defined as having a first episode of major depression at age 60 or later. We characterized the three groups of patients with respect to baseline demographic, neuropsychological, and clinical characteristics, use of augmentation pharmacotherapy to achieve response, and treatment outcomes.
Rates of response, remission, relapse, and termination were similar in all three groups; however, patients with late-onset, recurrent major depression took longer to respond to treatment than those with late-onset, single-episode depression (12 weeks vs 8 weeks) and had more cognitive and functional impairment. Additionally, patients with recurrent depression (whether early or late) were more likely to require pharmacotherapy augmentation to achieve response than patients with a single lifetime episode.
Late-onset, recurrent depression takes longer to respond to treatment than late-onset single-episode depression and is more strongly associated with cognitive and functional impairment. Further study of biological, neuropsychologic, and psychosocial correlates of late-onset, recurrent depression is needed.
探讨晚发性与早发性非双相、非精神病性重度抑郁症的临床及治疗反应变异性。
我们根据病程特征对一项老年抑郁症治疗研究中的患者进行分组：早发性复发性抑郁症患者（n = 59）、晚发性复发性抑郁症患者（n = 27）和晚发性单次发作抑郁症患者（n = 95）。早发性定义为首次重度抑郁症发作年龄在59岁或更早；晚发性定义为首次重度抑郁症发作年龄在60岁或更晚。我们对三组患者的基线人口统计学、神经心理学和临床特征、使用增效药物治疗以达到反应以及治疗结果进行了描述。
三组患者的反应率、缓解率、复发率和终止治疗率相似；然而，晚发性复发性重度抑郁症患者对治疗的反应时间比晚发性单次发作抑郁症患者更长（12周对8周），且有更多的认知和功能损害。此外，复发性抑郁症患者（无论早发还是晚发）比单次发作抑郁症患者更有可能需要药物增效治疗以达到反应。
晚发性复发性抑郁症对治疗的反应时间比晚发性单次发作抑郁症更长，且与认知和功能损害的关联更强。需要对晚发性复发性抑郁症的生物学、神经心理学和社会心理相关性进行进一步研究。
