Baldwin David S, Stein Dan J, Dolberg Ornah T, Bandelow Borwin
Clinical Neuroscience Division, School of Medicine, University of Southampton, Southampton, UK.
Hum Psychopharmacol. 2009 Jun;24(4):269-75. doi: 10.1002/hup.1019.
To extend the knowledge of course of improvement in patients with major depressive disorder (MDD), social anxiety disorder (SAD) or generalised anxiety disorder (GAD) participating in randomised placebo-controlled trials (RCTs) and to infer the optimal duration of initial escitalopram treatment in clinical practice, after which intervention might be reasonable in case of non-response.
Post hoc analysis of pooled clinical trial database for escitalopram in MDD (14 studies), GAD (4 studies) and SAD (2 studies). 'Onset' of action was defined as a 20% or more decrease from baseline score in disorder-specific psychopathological rating scales: 'response' as a 50% or more decrease from baseline score.
In MDD, the probability of responding at week 8 if no onset was apparent at week 2 was 43%; in patients with an onset of effect the probability was nearly 80%. Similar patterns were observed in GAD and SAD. The chance of responding beyond week 4 in MDD, GAD and SAD was 20% or less if no effect had occurred by week 2.
The pattern of response in these RCTs suggests that in patients with MDD, GAD or SAD in wider clinical practice, a period of at least 4 weeks is worthwhile before considering further intervention.
拓展对参与随机安慰剂对照试验（RCT）的重度抑郁症（MDD）、社交焦虑障碍（SAD）或广泛性焦虑障碍（GAD）患者改善过程的认识，并推断临床实践中初始艾司西酞普兰治疗的最佳持续时间，若治疗无反应，在此之后进行进一步干预可能是合理的。
对艾司西酞普兰治疗MDD（14项研究）、GAD（4项研究）和SAD（2项研究）的汇总临床试验数据库进行事后分析。“起效”定义为特定疾病精神病理学评定量表中的得分较基线得分降低20%或更多；“反应”定义为得分较基线得分降低50%或更多。
在MDD中，若第2周未出现起效，则第8周有反应的概率为43%；对于出现起效的患者，该概率接近80%。在GAD和SAD中观察到类似模式。在MDD、GAD和SAD中，若第2周未产生效果，则第4周之后有反应的机会为20%或更低。
这些RCT中的反应模式表明，在更广泛的临床实践中，对于MDD、GAD或SAD患者，在考虑进一步干预之前，至少4周的治疗期是值得的。
