MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK.
J Affect Disord. 2010 Dec;127(1-3):337-42. doi: 10.1016/j.jad.2010.06.011. Epub 2010 Jul 6.
The occurrence of stressful life events (SLEs) has been shown to predict response to antidepressants; however, results are inconsistent. There is some evidence to suggest that SLEs prior to treatment are associated with greater cognitive symptoms at baseline and may therefore predict changes in these symptoms specifically.
GENDEP, a prospective part-randomised pharmacogenomics trial, collected longitudinal data on the symptoms of patients with major depression treated with either a selective serotonin reuptake inhibitor (SSRI, escitalopram) or a tricyclic antidepressant (TCA, nortriptyline). Data on life events experienced in the 6 months preceding treatment measured using the List of Threatening Experiences Questionnaire (LTE-Q) were available for 728 participants.
Both the occurrence and number of SLEs were associated with greater cognitive but not mood or neurovegetative symptoms prior to treatment. Those who reported SLEs also experienced a greater decline in cognitive symptoms during treatment with escitalopram, but not with nortriptyline.
Life events were measured retrospectively using a self-report checklist and are therefore subject to a number of biases especially in the context of depressive illness.
These findings are in line with cognitive theories of depression and suggest that symptomatic heterogeneity may have contributed to inconsistencies in studies reported to date. Our results also tentatively suggest a clinically relevant drug specific effect of SLEs. Specifically, those reporting stress may benefit more from treatment with SSRIs than TCAs.
应激性生活事件（SLE）的发生已被证明可预测抗抑郁药的反应；然而，结果并不一致。有一些证据表明，治疗前的 SLE 与基线时更大的认知症状有关，因此可能专门预测这些症状的变化。
GENDEP 是一项前瞻性部分随机药物基因组学试验，收集了接受选择性 5-羟色胺再摄取抑制剂（SSRI，依他普仑）或三环类抗抑郁药（TCA，去甲替林）治疗的重度抑郁症患者症状的纵向数据。使用威胁体验清单（LTE-Q）对治疗前 6 个月经历的生活事件进行了评估，共 728 名参与者的数据可用。
SLE 的发生和数量都与治疗前更大的认知症状相关，但与情绪或神经植物性症状无关。那些报告 SLE 的人在接受依他普仑治疗期间认知症状的下降也更大，但在接受去甲替林治疗时则不然。
生活事件是使用自我报告清单回顾性测量的，因此存在许多偏见，尤其是在抑郁疾病的背景下。
这些发现与抑郁的认知理论一致，并表明症状异质性可能导致迄今为止报告的研究存在不一致。我们的结果还初步表明 SLE 具有临床相关的药物特异性作用。具体来说，那些报告有压力的人可能从 SSRI 治疗中获益更多，而不是从 TCA 治疗中获益更多。
