Vergouwen Anton C, Burger Huibert, Koerselman Frank, Verheij Theo J
Department of Psychiatry, St. Lucas Andreas Hospital, Amsterdam.
Prim Care Companion J Clin Psychiatry. 2007;9(5):364-6. doi: 10.4088/pcc.v09n0505.
In depression treatment, switching treatment after lack of initial improvement, e.g., after 6 weeks, may result in a better outcome. The extent of the lack of initial improvement, as well as the timing of its assessment on the basis of which treatment change may be considered, remains unclear. This study compared the relationships of several grades of symptom improvement after 2 and 6 weeks with remission after 10 weeks in depressed patients treated with antidepressants in primary care.
This was a prospective cohort study, conducted between January 1999 and September 2001 in primary care practices in the Netherlands, of 172 patients starting selective serotonin reup-take inhibitor (SSRI) treatment for major depressive disorder, diagnosed according to DSM-IV criteria. At weeks 2 and 6, patients were classified as unimproved, partially improved, or improved. For each category, we calculated the proportion of remission at week 10. The primary outcome measure was the Beck Depression Inventory.
Of the unimproved or partially improved patients at week 6, 29% (95% CI = 18 to 43) and 27% (95% CI = 17 to 40) attained remission at week 10, respectively.
These data suggest that, in primary care, depression treatment with an SSRI should be reconsidered in depressed patients who are unimproved or partially improved by week 6.
在抑郁症治疗中，初始治疗6周左右若未见改善则更换治疗方法，可能会带来更好的疗效。然而，初始治疗未改善的程度以及据此考虑更换治疗方法时的评估时机仍不明确。本研究比较了在初级保健机构中接受抗抑郁药物治疗的抑郁症患者，在治疗2周和6周后不同程度症状改善与10周后病情缓解之间的关系。
这是一项前瞻性队列研究，于1999年1月至2001年9月在荷兰的初级保健机构中开展，研究对象为172例开始接受选择性5-羟色胺再摄取抑制剂（SSRI）治疗的重度抑郁症患者，这些患者均根据《精神疾病诊断与统计手册》第四版（DSM-IV）标准进行诊断。在第2周和第6周时，将患者分为未改善、部分改善或改善三类。针对每一类患者，我们计算了第10周时病情缓解的比例。主要结局指标为贝克抑郁量表。
在第6周时未改善或部分改善的患者中，分别有29%（95%可信区间=18%至43%）和27%（95%可信区间=17%至40%）在第10周时达到病情缓解。
这些数据表明，在初级保健中，对于到第6周时仍未改善或仅部分改善的抑郁症患者，应重新考虑使用SSRI进行抑郁症治疗。
