Zisook Sidney, Lesser Ira, Stewart Jonathan W, Wisniewski Stephen R, Balasubramani G K, Fava Maurizio, Gilmer William S, Dresselhaus Timothy R, Thase Michael E, Nierenberg Andrew A, Trivedi Madhukar H, Rush A John
Department of Psychiatry, University of California, San Diego, CA 92093, USA.
Am J Psychiatry. 2007 Oct;164(10):1539-46. doi: 10.1176/appi.ajp.2007.06101757.
This report assesses whether age at onset defines a specific subgroup of major depressive disorder in 4,041 participants who entered the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study.
The study enrolled outpatients 18-75 years of age with nonpsychotic major depressive disorder from both primary care and psychiatric care practices. At study entry, participants estimated the age at which they experienced the onset of their first major depressive episode. This report divides the population into five age-at-onset groups: childhood onset (ages <12), adolescent onset (ages 12-17), early adult onset (ages 18-44), middle adult onset (ages 45-59), and late adult onset (ages > or =60).
No group clearly stood out as distinct from the others. Rather, the authors observed an apparent gradient, with earlier ages at onset associated with never being married, more impaired social and occupational function, poorer quality of life, greater medical and psychiatric comorbidity, a more negative view of life and the self, more lifetime depressive episodes and suicide attempts, and greater symptom severity and suicidal ideation in the index episode compared to those with later ages at onset of major depressive disorder.
Although age at onset does not define distinct depressive subgroups, earlier onset is associated with multiple indicators of greater illness burden across a wide range of indicators. Age of onset was not associated with a difference in treatment response to the initial trial of citalopram.
本报告评估了在4041名参与缓解抑郁的序贯治疗方案（STAR*D）研究的参与者中，发病年龄是否能界定出一个特定的重度抑郁症亚组。
该研究纳入了来自初级保健和精神科的18 - 75岁非精神病性重度抑郁症门诊患者。在研究开始时，参与者估计了他们首次经历重度抑郁发作的年龄。本报告将人群分为五个发病年龄组：儿童期发病（年龄<12岁）、青少年期发病（年龄12 - 17岁）、成年早期发病（年龄18 - 44岁）、成年中期发病（年龄45 - 59岁）和成年晚期发病（年龄≥60岁）。
没有一个组明显与其他组不同。相反，作者观察到一种明显的梯度，与重度抑郁症发病较晚的人相比，发病年龄较早的人存在以下情况：从未结婚、社会和职业功能受损更严重、生活质量较差、有更多的医学和精神科合并症、对生活和自我的看法更消极、有更多的终生抑郁发作和自杀未遂经历，以及在本次发作中症状更严重和有自杀观念。
虽然发病年龄并不能界定出不同的抑郁亚组，但较早发病与广泛指标中更高疾病负担中的多个指标相关。发病年龄与对西酞普兰初始试验的治疗反应差异无关。
