Dombrovski Alexandre Y, Lenze Eric J, Dew Mary Amanda, Mulsant Benoit H, Pollock Bruce G, Houck Patricia R, Reynolds Charles F
Western Psychiatric Institute and Clinic, Department of Psychiatry, School of Medicine, University of Pittsburgh, Pennsylvania, USA.
J Am Geriatr Soc. 2007 Sep;55(9):1325-32. doi: 10.1111/j.1532-5415.2007.01292.x.
To determine whether maintenance antidepressant pharmacotherapy and interpersonal psychotherapy sustain gains in health-related quality of life (HR-QOL) achieved during short-term treatment in older patients with depression.
After open combined treatment with paroxetine and interpersonal psychotherapy, responders were randomly assigned to a two (paroxetine vs placebo) by two (monthly interpersonal psychotherapy vs clinical management) double-blind, placebo-controlled maintenance trial. HR-QOL outcomes were assessed over 1 year.
University-based clinic.
Of the referred sample of 363 persons aged 70 and older with major depression, 210 gave consent, and 195 started acute treatment; 116 met criteria for recovery, entered maintenance treatment, and were included in this analysis.
Paroxetine; monthly manual-based interpersonal psychotherapy.
Overall HR-QOL as measured using the Quality of Well-Being Scale (QWB) and six specific HR-QOL domains derived from the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) subscales.
All domains of HR-QOL except physical functioning improved with successful acute and continuation treatment. After controlling for any effects of psychotherapy, pharmacotherapy was superior to placebo in preserving overall well-being (P=.04, effect size (r)=0.23), social functioning (P=.02, r=0.27), and role limitations due to emotional problems (P=.007, r=0.30). Interpersonal psychotherapy (controlling for the effects of pharmacotherapy) did not preserve HR-QOL better than supportive clinical management.
Maintenance antidepressant pharmacotherapy is superior to placebo in preserving improvements in overall well-being achieved with treatment response in late-life depression. No such benefit was seen with interpersonal psychotherapy.
确定维持性抗抑郁药物治疗和人际心理治疗能否维持老年抑郁症患者在短期治疗期间所获得的健康相关生活质量（HR-QOL）改善。
在接受帕罗西汀与人际心理治疗联合开放治疗后，对有反应者进行随机分组，开展一项2×2双盲、安慰剂对照的维持试验（2种药物：帕罗西汀与安慰剂；2种干预方式：每月一次人际心理治疗与临床管理）。对HR-QOL结局进行为期1年的评估。
大学附属医院门诊。
在363名年龄≥70岁的重度抑郁症转诊样本中，210人同意参与，195人开始接受急性治疗；116人达到康复标准，进入维持治疗阶段，并纳入本分析。
帕罗西汀；每月一次基于手册的人际心理治疗。
使用幸福感量表（QWB）测量总体HR-QOL，并采用医学结局研究36项简明健康调查（SF-36）分量表得出的6个特定HR-QOL领域。
除身体功能外，成功的急性和延续性治疗使HR-QOL的所有领域均得到改善。在控制心理治疗的任何影响后，药物治疗在维持总体幸福感（P = 0.04，效应量（r）= 0.23）、社会功能（P = 0.02，r = 0.27）以及因情感问题导致的角色受限方面（P = 0.007，r = 0.30）优于安慰剂。人际心理治疗（控制药物治疗的影响）在维持HR-QOL方面并不优于支持性临床管理。
在维持老年抑郁症治疗反应所带来的总体幸福感改善方面，维持性抗抑郁药物治疗优于安慰剂。人际心理治疗未显示出此类益处。
