McGrath Patrick J, Stewart Jonathan W, Quitkin Frederic M, Chen Ying, Alpert Jonathan E, Nierenberg Andrew A, Fava Maurizio, Cheng Jianfeng, Petkova Eva
Depression Evaluation Service, New York State Psychiatric Institute, 1051 Riverside Dr., New York, NY 10032-1007, USA.
Am J Psychiatry. 2006 Sep;163(9):1542-8. doi: 10.1176/ajp.2006.163.9.1542.
Loss of response to a previously effective antidepressant is a common clinical problem. Retrospective analyses have shown that the pattern of response during antidepressant treatment (late onset and persistent versus other patterns) can be used to predict relapse during continuation and maintenance treatment and possibly to identify placebo responses to treatment. This study was designed to test the predictive value of response pattern prospectively and to examine the data for other predictors of relapse.
Five hundred seventy persons with major depressive disorder were treated with fluoxetine for 12 weeks and their pattern of response was determined. Those who responded (N=292) underwent random assignment, under double-blind conditions, to continue taking fluoxetine or to switch to placebo for 52 weeks or until relapse. Survival analysis was used to examine the effect of covariates on relapse.
Although fluoxetine was significantly more effective than placebo during maintenance treatment, this chronically ill group had a high rate of relapse. Contrary to previous findings, a pattern of acute response was not predictive of relapse. Chronicity, symptom severity, a neurovegetative symptom pattern, and female gender were all associated with a significantly greater risk of relapse, with no difference observed between fluoxetine and placebo.
The pattern of response to acute treatment appears to be inconsistently predictive of relapse. There is a high rate of relapse with both active medication and placebo in patients with chronic depression. Illness characteristics predict loss of response both to fluoxetine and to placebo. No variable examined was predictive of differential relapse rates between fluoxetine and placebo.
对先前有效的抗抑郁药失去反应是一个常见的临床问题。回顾性分析表明，抗抑郁治疗期间的反应模式（迟发性和持续性与其他模式）可用于预测继续治疗和维持治疗期间的复发情况，并可能识别对治疗的安慰剂反应。本研究旨在前瞻性地测试反应模式的预测价值，并检查其他复发预测因素的数据。
570名重度抑郁症患者接受氟西汀治疗12周，并确定其反应模式。有反应者（N = 292）在双盲条件下进行随机分组，继续服用氟西汀或改用安慰剂，为期52周或直至复发。采用生存分析来检查协变量对复发的影响。
尽管在维持治疗期间氟西汀比安慰剂显著更有效，但这个慢性病群体的复发率很高。与先前的研究结果相反，急性反应模式并不能预测复发。慢性病、症状严重程度、神经植物性症状模式和女性性别均与显著更高的复发风险相关，氟西汀和安慰剂之间未观察到差异。
急性治疗的反应模式似乎并不能一致地预测复发。慢性抑郁症患者使用活性药物和安慰剂的复发率都很高。疾病特征可预测对氟西汀和安慰剂的反应丧失。所检查的变量均不能预测氟西汀和安慰剂之间的差异复发率。
