Department of Psychiatry, University of California San Francisco, CA, USA.
Int J Geriatr Psychiatry. 2009 May;24(5):539-44. doi: 10.1002/gps.2233.
Previous studies of mixed aged and older adult samples with major depressive disorder (MDD) reported reduced depression response in anxious patients, but a systematic review and analysis has not been performed. Our aim was to determine if anxiety predicts antidepressant response in previously identified placebo-controlled trials of second generation antidepressants for late-life depression.
From a previous systematic review that identified ten randomized, placebo-controlled trials of community dwelling patients aged 60 or older with major depression, anxious patients were identified by a score >or=7 on the anxiety/somatization factor of the Hamilton Depression Rating Scale (HDRS). Response was defined as 50% or greater improvement on the HDRS or the Montgomery Asberg Depression Rating Scale. A meta-analysis was performed using a random effects model to calculate Odds Ratios (OR).
Data were available from eight trials having ten drug-placebo contrasts that included 2322 anxious and 1387 non-anxious patients. The odds ratio for response to drug compared to placebo in anxious patients was 1.57 (95% CI 1.15, 2.14; z = 2.86, n = 10, p < 0.001), in non-anxious patients was 1.44 (95% CI 1.15, 1.80, z = 3.21, n = 10, p < 0.001), and did not differ between groups. Pooled response rates to drug and placebo respectively were 49.4% vs 37.4% in anxious patients and 44.2 vs 35.5% in non-anxious patients.
In randomized, placebo-controlled trials, anxiety in late-life depression was not associated with decreased response to second generation antidepressants.
以前对伴有重度抑郁症（MDD）的混合年龄和老年患者样本的研究报告称，焦虑患者的抑郁反应降低，但尚未进行系统回顾和分析。我们的目的是确定在以前确定的针对老年抑郁症的第二代抗抑郁药的安慰剂对照试验中，焦虑是否预测抗抑郁药的反应。
从之前的一项系统评价中，我们确定了 10 项随机、安慰剂对照的临床试验，这些试验纳入了年龄在 60 岁或以上、患有重度抑郁症的社区居住患者，通过汉密尔顿抑郁量表（HDRS）的焦虑/躯体化因子得分≥7 来识别焦虑患者。反应定义为 HDRS 或蒙哥马利抑郁评定量表（MADRS）的评分至少改善 50%。使用随机效应模型进行荟萃分析以计算优势比（OR）。
数据来自 8 项试验，其中有 10 个药物-安慰剂对照，包括 2322 名焦虑患者和 1387 名非焦虑患者。与安慰剂相比，焦虑患者对药物的反应优势比为 1.57（95%CI 1.15, 2.14；z = 2.86，n = 10，p < 0.001），非焦虑患者为 1.44（95%CI 1.15, 1.80，z = 3.21，n = 10，p < 0.001），且两组之间无差异。药物和安慰剂的总体反应率分别为焦虑患者 49.4%对 37.4%，非焦虑患者 44.2%对 35.5%。
在随机、安慰剂对照试验中，老年抑郁症中的焦虑与第二代抗抑郁药的反应降低无关。
