Leykin Yan, Amsterdam Jay D, DeRubeis Robert J, Gallop Robert, Shelton Richard C, Hollon Steven D
Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104-6196, USA.
J Consult Clin Psychol. 2007 Apr;75(2):267-76. doi: 10.1037/0022-006X.75.2.267.
Recent research suggests that there may be a reduction in therapeutic response after multiple administrations of antidepressant drug (AD) therapy in patients with major depressive disorder. This study assessed the response to AD therapy and cognitive therapy (CT) of patients with a history of prior AD exposures. A sample of 240 patients with moderate-to-severe major depressive disorder entered a randomized controlled trial comparing pharmacotherapy with paroxetine to CT. Treatment was administered for 16 weeks. History of prior AD exposure was assessed with structured interviews, self-report, and medical records. Analyses were conducted using hierarchical linear models on the intent-to-treat sample. After controlling for various demographic and clinical factors, more prior AD exposures predicted poor response to paroxetine therapy but not to CT, as measured by the Hamilton Rating Scale for Depression (Hamilton, 1960; Williams, 1988). Whereas CT outcome was not significantly related to the number of prior AD exposures, a higher number of prior AD exposures was significantly associated with a lower response to paroxetine. If these findings are replicated in methodologically rigorous studies of paroxetine and other antidepressants, CT should be recommended, in preference to AD, for patients with multiple prior AD exposures.
近期研究表明，重度抑郁症患者多次接受抗抑郁药物（AD）治疗后，治疗反应可能会降低。本研究评估了有过AD治疗史的患者对AD治疗和认知疗法（CT）的反应。240例中重度重度抑郁症患者样本进入一项随机对照试验，比较帕罗西汀药物治疗与CT治疗。治疗持续16周。通过结构化访谈、自我报告和医疗记录评估既往AD治疗史。对意向性治疗样本使用分层线性模型进行分析。在控制了各种人口统计学和临床因素后，如用汉密尔顿抑郁量表（汉密尔顿，1960年；威廉姆斯，1988年）测量，更多的既往AD治疗史预示着对帕罗西汀治疗反应不佳，但对CT治疗反应并非如此。虽然CT治疗结果与既往AD治疗次数无显著相关性，但既往AD治疗次数较多与对帕罗西汀的反应较低显著相关。如果这些发现在对帕罗西汀和其他抗抑郁药进行的方法学严谨的研究中得到重复验证，对于有多次既往AD治疗史的患者，应优先推荐CT而非AD。
