Department of Psychiatry, Advanced Center for Interventions and Services Research for Late-Life Mood Disorders, Clinical Trials Management Unit, University of Pittsburgh School of Medicine, PA, USA.
Int J Geriatr Psychiatry. 2010 Nov;25(11):1134-41. doi: 10.1002/gps.2443.
More than half of the older adults respond only partially to first-line antidepressant pharmacotherapy. Our objective was to test the hypothesis that a depression-specific psychotherapy, Interpersonal Psychotherapy (IPT), when used adjunctively with escitalopram, would lead to a higher rate of remission and faster resolution of symptoms in partial responders than escitalopram with depression care management (DCM).
We conducted a 16-week randomized clinical trial of IPT and DCM in partial responders to escitalopram, enrolling 124 outpatients aged 60 and older. The primary outcome, remission, was defined as three consecutive weekly scores of 7 or less on the Hamilton rating scale for depression (17-item). We conducted Cox regression analyses of time to remission and logistic modeling for rates of remission. We tested group differences in Hamilton depression ratings over time via mixed-effects modeling.
Remission rates for escitalopram with IPT and with DCM were similar in intention-to-treat (IPT vs. DCM: 58 [95% CI: 46, 71] vs. 45% [33,58]; p = 0.14) and completer analyses (IPT vs. DCM: 58% [95% CI: 44,72] vs. 43% [30,57]; p = 0.20). Rapidity of symptom improvement did not differ in the two treatments.
No added advantage of IPT over DCM was shown. DCM is a clinically useful strategy to achieve full remission in about 50% of partial responders.
超过一半的老年人对一线抗抑郁药物治疗仅部分反应。我们的目的是检验以下假设，即一种特定于抑郁的心理治疗（人际心理治疗，IPT）与依他普仑联合使用，会比依他普仑联合抑郁护理管理（DCM）更能提高部分反应者的缓解率，并更快地缓解症状。
我们对依他普仑部分反应的 124 名 60 岁及以上门诊患者进行了为期 16 周的 IPT 和 DCM 随机临床试验。主要结局是缓解，定义为汉密尔顿抑郁量表（17 项）连续 3 周每周得分 7 或以下。我们对缓解时间进行了 Cox 回归分析，并对缓解率进行了逻辑建模。我们通过混合效应模型测试了组间随时间变化的汉密尔顿抑郁评分差异。
意向治疗（IPT 与 DCM：58 [95%CI：46，71] 与 45% [33,58]；p = 0.14）和完成者分析（IPT 与 DCM：58% [95%CI：44,72] 与 43% [30,57]；p = 0.20）的依他普仑联合 IPT 和 DCM 的缓解率相似。两种治疗方法的症状改善速度没有差异。
IPT 并没有比 DCM 更有优势。DCM 是一种在约 50%的部分反应者中实现完全缓解的临床有用策略。
