Morris David W, Trivedi Madhukar H, Fava Maurizio, Wisniewski Stephen R, Balasubramani G K, Khan Ahsan Y, Jain Shailesh, Rush A John
Mood Disorders Program and Clinic, Department of Psychiatry, University of Texas Southwestern Medical Center, Exchange Park Express, American General Tower, 6363 Forest Park Road, Suite 13.354, Dallas, TX 75390-9119, USA.
Depress Anxiety. 2009;26(9):851-63. doi: 10.1002/da.20557.
Diurnal mood variation (DMV) with early morning worsening is considered a classic symptom of melancholic features of major depressive disorder (MDD) according to the Diagnostic and Statistical Manual. This report used data from the sequenced treatment alternatives to relieve depression study to determine whether DMV was associated with treatment outcome to citalopram.
Two thousand eight hundred and seventy-five outpatients with nonpsychotic MDD were evaluated during a 14-week trial of the selective serotonin reuptake inhibitor citalopram. Participants were divided into three groups: those with "classic" DMV (early morning worsening), those with any form of DMV (morning, afternoon, or evening worsening), and those with no DMV. Participants with classic DMV and those with any form of DMV were compared to those with no DMV in terms of baseline sociodemographic and clinical characteristics, treatment outcomes, and treatment features.
Minor baseline clinical characteristics and treatment feature differences were found between participants with and without DMV. Participants with classic morning DMV had slightly higher response rates than those without DMV. However, no differences were found in response or remission between either group of participants with DMV and those with no DMV.
DMV does not appear to be associated with a unique prominent pattern of response to selective serotonin reuptake inhibitor treatment in patients with depression, and does not appear to be a serotonergically modulated process. Further evaluation is necessary to determine if this relationship holds true for dopaminergic and noradrenergic antidepressant agents, such as dual-acting agents or antidepressant medication combinations.
根据《诊断与统计手册》，伴有清晨病情加重的昼夜情绪变化（DMV）被认为是重度抑郁症（MDD）抑郁特征的经典症状。本报告使用缓解抑郁症研究的序贯治疗方案中的数据，以确定DMV是否与西酞普兰的治疗结果相关。
在一项为期14周的选择性5-羟色胺再摄取抑制剂西酞普兰试验中，对2875名非精神病性MDD门诊患者进行了评估。参与者被分为三组：有“典型”DMV（清晨病情加重）的患者、有任何形式DMV（早晨、下午或晚上病情加重）的患者和无DMV的患者。在基线社会人口统计学和临床特征、治疗结果及治疗特征方面，将有典型DMV的参与者和有任何形式DMV的参与者与无DMV的参与者进行比较。
在有和没有DMV的参与者之间发现了微小的基线临床特征和治疗特征差异。有典型清晨DMV的参与者的缓解率略高于无DMV的参与者。然而，在有DMV的两组参与者与无DMV的参与者之间，在缓解或痊愈方面未发现差异。
DMV似乎与抑郁症患者对选择性5-羟色胺再摄取抑制剂治疗的独特显著反应模式无关，且似乎不是一个受5-羟色胺能调节的过程。有必要进行进一步评估，以确定这种关系对于多巴胺能和去甲肾上腺素能抗抑郁药（如双效药物或抗抑郁药组合）是否成立。
