Kok Rob M, Vink Dagmar, Heeren Thea J, Nolen Willem A
Department of Old Age Psychiatry, Altrecht Institute of Mental Health Care, Utrecht, The Netherlands.
J Clin Psychiatry. 2007 Aug;68(8):1177-85. doi: 10.4088/jcp.v68n0803.
Up to a third of elderly patients with major depressive disorder do not respond to a first course of treatment with an antidepressant. There is a lack of controlled studies evaluating therapies for treatment-resistant depression in late-life depression, and no randomized controlled studies assessing the efficacy and tolerability of lithium augmentation in elderly patients have been published.
Twenty-nine elderly inpatients with major depressive disorder according to DSM-IV criteria who had previously failed to respond to 1 or more adequate trials with a tricyclic antidepressant or venlafaxine were included in a 6-week, open, randomized, controlled study with a 2-year follow-up. Subjects received either lithium augmentation or the monoamine oxidase inhibitor phenelzine. The primary outcome criterion was remission, defined as a final score of less than or equal to 10 on the Montgomery-Asberg Depression Rating Scale (MADRS). Response was defined as at least 50% reduction on the MADRS or the Hamilton Rating Scale for Depression (HAM-D).
Twenty-eight subjects completed the trial. Remission on the MADRS was achieved by 33.3% of the lithium patients, compared with none of the phenelzine patients (p = .042). Response also showed a difference in favor of lithium augmentation (p = .035 on both the MADRS and the HAM-D). Overall tolerability was good, with no dropouts due to side effects. Subjective memory impairment was more prevalent among patients receiving phenelzine (p = .002), and tremors were significantly more prevalent among patients receiving lithium (p = .002). During the 2-year follow-up, 25 patients (86.2%) did achieve remission, particularly on prolonging the lithium treatment (5 patients) or on lithium augmentation to phenelzine (5 patients).
Lithium was more effective than phenelzine in elderly patients with treatment-resistant major depressive disorder, while tolerance of both treatments was remarkably good in this group of elderly inpatients with many comorbid medical disorders.
Controlled-trials.com identifier is RCTN93105957.
高达三分之一的老年重度抑郁症患者对第一轮抗抑郁药物治疗无反应。缺乏针对老年期抑郁症难治性抑郁症治疗方法的对照研究，且尚未发表评估老年患者锂盐增效疗效和耐受性的随机对照研究。
根据《精神疾病诊断与统计手册》第四版（DSM-IV）标准，选取29例曾对三环类抗抑郁药或文拉法辛进行1次或多次充分试验但无反应的老年重度抑郁症住院患者，纳入一项为期6周的开放、随机对照研究，并进行2年随访。受试者接受锂盐增效治疗或单胺氧化酶抑制剂苯乙肼治疗。主要结局标准为缓解，定义为蒙哥马利-艾斯伯格抑郁量表（MADRS）最终得分小于或等于10分。反应定义为MADRS或汉密尔顿抑郁量表（HAM-D）得分至少降低50%。
28例受试者完成试验。锂盐治疗组33.3%的患者实现MADRS缓解，而苯乙肼治疗组无一例缓解（p = 0.042）。反应情况也显示锂盐增效更具优势（MADRS和HAM-D均为p = 0.035）。总体耐受性良好，无因副作用而退出试验者。接受苯乙肼治疗的患者主观记忆障碍更为普遍（p = 0.002），接受锂盐治疗的患者震颤更为显著（p = 0.002）。在2年随访期间，25例患者（8．62%）实现缓解，尤其是延长锂盐治疗（5例）或锂盐增效联合苯乙肼治疗（5例）。
对于难治性重度抑郁症老年患者，锂盐比苯乙肼更有效，而在这组患有多种合并内科疾病的老年住院患者中，两种治疗的耐受性均相当良好。
Controlled-trials.com标识符为RCTN93105957。
