Marangell Lauren B, Dennehy Ellen B, Miyahara Sachiko, Wisniewski Stephen R, Bauer Mark S, Rapaport Mark Hyman, Allen Michael H
Mood Disorders Center, Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX, United States.
J Affect Disord. 2009 Apr;114(1-3):58-67. doi: 10.1016/j.jad.2008.07.006. Epub 2008 Aug 15.
This report describes baseline characteristics and functional outcomes of subjects who have prospectively observed subsyndromal symptoms after a major depressive episode (MDE).
All subjects were participants in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). We identified subjects with at least 2 years of observation whose prior or current episode was a MDE, and who were in a stable clinical state of either recovered (no more than 2 moderate symptoms for at least 8 weeks), a MDE by DSM-IV criteria, or with continued subsyndromal symptoms. The subsyndromal group was defined a priori as 3 or more moderate affective symptoms but without meeting diagnostic criteria for major depression.
The final cohort included 1094 recovered, 112 subsyndromal, and 310 individuals in a MDE. The average time spent in each clinical status ranged from 120 to 132 days. The subsyndromal group was most similar to those in a MDE, differing only on the intensity of depressive symptoms and the number of work days missed due to ongoing symptoms. Reported sadness, inability to feel and lassitude were each associated with multiple measures of impairment.
This study is limited by the cross-sectional approach to defining outcomes.
These findings are consistent with studies in unipolar major depression that indicate that functional impairment observed in the context of subsyndromal depressive symptoms is comparable to that of a full episode. This work underscores the need to include subsyndromal symptoms in study outcomes and to target full remission in clinical practice.
本报告描述了在经历重度抑郁发作（MDE）后前瞻性观察到亚综合征症状的受试者的基线特征和功能结局。
所有受试者均为双相情感障碍系统治疗强化项目（STEP-BD）的参与者。我们确定了至少有2年观察期、既往或当前发作是MDE且处于稳定临床状态的受试者，这些状态包括康复（至少8周内不超过2个中度症状）、符合DSM-IV标准的MDE或持续存在亚综合征症状。亚综合征组预先定义为有3种或更多中度情感症状但不符合重度抑郁诊断标准的组。
最终队列包括1094名康复者、112名亚综合征患者和310名处于MDE发作期的个体。在每种临床状态下花费的平均时间为120至132天。亚综合征组与处于MDE发作期的组最为相似，仅在抑郁症状强度和因持续症状而错过的工作日数量上有所不同。报告的悲伤、情感麻木和倦怠均与多种损害指标相关。
本研究受限于采用横断面方法定义结局。
这些发现与单相重度抑郁症的研究一致，表明在亚综合征抑郁症状背景下观察到的功能损害与完全发作时相当。这项工作强调了在研究结局中纳入亚综合征症状以及在临床实践中以实现完全缓解为目标的必要性。
