Charité-Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany.
J Clin Psychiatry. 2010 Aug;71(8):1047-54. doi: 10.4088/JCP.09m05650blu. Epub 2010 Jul 13.
The objective of this study was to explore the prevalence of anxious depression in an inpatient population, to describe its clinical and sociodemographic correlates, and to compare treatment outcomes between patients with anxious and nonanxious depression. Furthermore, the efficacy of algorithm-guided treatment versus treatment as usual in patients with anxious versus nonanxious depression was evaluated.
Data were collected on 429 inpatients with the diagnosis of a depressive episode (according to ICD-10) and a score of ≥ or = 15 on the 21-item Hamilton Depression Rating Scale (HDRS-21). The German Algorithm Project, phase 3 (GAP3), was conducted between 2000 and 2005 in 10 psychiatric departments throughout Germany. A baseline HDRS-21 anxiety/somatization factor score of ≥ or = 7 was considered indicative of anxious depression. Remission was defined as an HDRS-21 score or ≤ = 9. To evaluate the efficacy of algorithm-guided treatment, patients were randomly assigned into 3 groups: 2 different treatment algorithms or treatment as usual.
The prevalence of anxious depression was 49%. Patients with anxious depression were more likely than those with nonanxious depression to be older (mean ± SD = 45.3 ± 12.8 vs 42.9 ± 12.0 years, odds ratio [OR] = 1.02 [95% CI, 1.00-1.03], P = .046), retired (70% vs 30%, OR = 3.09 [95% CI, 1.70-5.62], P = .000), without school qualification (74% vs 26%, OR = 3.11 [95% CI, 1.09-8.83], P = .035), more severely depressed (mean ± SD HDRS-21 score = 20.1 ± 5.0 vs 18.5 ± 4.4, OR = 1.08 [95% CI, 1.03-1.12], P = .001), and more likely to have a longer duration of the current episode (mean ± SD = 20.9 ± 26.2 vs 13.7 ± 14.3 weeks, OR = 1.02 [95% CI, 1.01-1.03], P = .011). Patients with anxious depression were more likely to display a variety of melancholic features. In patients with anxious depression compared to those with nonanxious depression, remission was less likely to be achieved (48.6% vs 61.5%, OR = 0.63 [95% CI, 0.42-0.92], P = .018) and took longer to occur (mean ± SD = 44 ± 3.4 vs 30 ± 2.8 days, HR = 0.65 [95% CI, 0.50-0.85], P = .001). There was no significant interaction with the treatment mode with regard to remission (Wald = 0.20, P = .890).
Anxious depression is common in patients diagnosed with depression. The poorer treatment outcome in patients with anxious depression demonstrates the need to address the issue of specific treatment strategies for this subgroup. However, anxious depression has no moderating effect on the efficacy of algorithm-guided treatment.
http://www.germanctr.de/ Identifier: DRKS00000161.
本研究旨在探讨住院患者中焦虑抑郁的患病率，描述其临床和社会人口学特征，并比较焦虑和非焦虑抑郁患者的治疗结局。此外，还评估了在焦虑和非焦虑抑郁患者中，基于算法的治疗与常规治疗相比的疗效。
我们收集了 429 名符合 ICD-10 诊断标准的抑郁发作患者（根据 ICD-10）和汉密尔顿抑郁量表（HDRS-21）得分≥或=15 的患者的数据。德国算法项目，第 3 阶段（GAP3），于 2000 年至 2005 年在德国 10 个精神病科进行。基线 HDRS-21 焦虑/躯体化因子得分≥或=7 被认为是焦虑性抑郁。缓解定义为 HDRS-21 评分≤或=9。为了评估基于算法的治疗效果，我们将患者随机分为 3 组：2 种不同的治疗算法或常规治疗。
焦虑性抑郁的患病率为 49%。与非焦虑性抑郁患者相比，焦虑性抑郁患者更有可能年龄较大（平均±标准差=45.3±12.8 岁 vs 42.9±12.0 岁，优势比[OR] = 1.02[95%可信区间，1.00-1.03]，P =.046）、退休（70% vs 30%，OR = 3.09[95%可信区间，1.70-5.62]，P =.000）、无学历（74% vs 26%，OR = 3.11[95%可信区间，1.09-8.83]，P =.035）、抑郁程度更严重（平均±标准差 HDRS-21 评分=20.1±5.0 分 vs 18.5±4.4 分，OR = 1.08[95%可信区间，1.03-1.12]，P =.001），且当前发作的持续时间更长（平均±标准差=20.9±26.2 周 vs 13.7±14.3 周，OR = 1.02[95%可信区间，1.01-1.03]，P =.011）。与非焦虑性抑郁患者相比，焦虑性抑郁患者更有可能表现出多种忧郁特征。与非焦虑性抑郁患者相比，焦虑性抑郁患者的缓解率较低（48.6% vs 61.5%，OR = 0.63[95%可信区间，0.42-0.92]，P =.018），缓解时间较长（平均±标准差=44±3.4 天 vs 30±2.8 天，HR = 0.65[95%可信区间，0.50-0.85]，P =.001）。治疗方式与缓解之间没有显著的交互作用（Wald = 0.20，P =.890）。
焦虑性抑郁在诊断为抑郁症的患者中很常见。焦虑性抑郁患者的治疗结局较差，表明需要针对这一亚组制定特定的治疗策略。然而，焦虑性抑郁对基于算法的治疗效果没有调节作用。
