Curry John, Silva Susan, Rohde Paul, Ginsburg Golda, Kratochvil Christopher, Simons Anne, Kirchner Jerry, May Diane, Kennard Betsy, Mayes Taryn, Feeny Norah, Albano Anne Marie, Lavanier Sarah, Reinecke Mark, Jacobs Rachel, Becker-Weidman Emily, Weller Elizabeth, Emslie Graham, Walkup John, Kastelic Elizabeth, Burns Barbara, Wells Karen, March John
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA.
Arch Gen Psychiatry. 2011 Mar;68(3):263-9. doi: 10.1001/archgenpsychiatry.2010.150. Epub 2010 Nov 1.
Major depressive disorder in adolescents is common and impairing. Efficacious treatments have been developed, but little is known about longer-term outcomes, including recurrence.
To determine whether adolescents who responded to short-term treatments or who received the most efficacious short-term treatment would have lower recurrence rates, and to identify predictors of recovery and recurrence.
Naturalistic follow-up study.
Twelve academic sites in the United States.
One hundred ninety-six adolescents (86 males and 110 females) randomized to 1 of 4 short-term interventions (fluoxetine hydrochloride treatment, cognitive behavioral therapy, their combination, or placebo) in the Treatment for Adolescents With Depression Study were followed up for 5 years after study entry (44.6% of the original Treatment for Adolescents With Depression Study sample).
Recovery was defined as absence of clinically significant major depressive disorder symptoms on the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version interview for at least 8 weeks, and recurrence was defined as a new episode of major depressive disorder following recovery.
Almost all participants (96.4%) recovered from their index episode of major depressive disorder during the follow-up period. Recovery by 2 years was significantly more likely for short-term treatment responders (96.2%) than for partial responders or nonresponders (79.1%) (P < .001) but was not associated with having received the most efficacious short-term treatment (the combination of fluoxetine and cognitive behavioral therapy). Of the 189 participants who recovered, 88 (46.6%) had a recurrence. Recurrence was not predicted by full short-term treatment response or by original treatment. However, full or partial responders were less likely to have a recurrence (42.9%) than were nonresponders (67.6%) (P = .03). Sex predicted recurrence (57.0% among females vs 32.9% among males; P = .02).
Almost all depressed adolescents recovered. However, recurrence occurs in almost half of recovered adolescents, with higher probability in females in this age range. Further research should identify and address the vulnerabilities to recurrence that are more common among young women.
青少年重度抑郁症很常见且会造成损害。虽然已经开发出了有效的治疗方法，但对于包括复发在内的长期预后情况却知之甚少。
确定对短期治疗有反应的青少年或接受了最有效短期治疗的青少年是否复发率更低，并确定康复和复发的预测因素。
自然随访研究。
美国的12个学术机构。
在青少年抑郁症治疗研究中，196名青少年（86名男性和110名女性）被随机分配到4种短期干预措施（盐酸氟西汀治疗、认知行为疗法、二者联合或安慰剂）中的一种，在研究入组后进行了5年的随访（占青少年抑郁症治疗研究原始样本的44.6%）。
康复被定义为在《学龄儿童情感障碍和精神分裂症量表（现患和终生版）》访谈中至少8周没有临床上显著的重度抑郁症症状，复发被定义为康复后出现重度抑郁症的新发作。
在随访期间，几乎所有参与者（96.4%）都从重度抑郁症的首次发作中康复。短期治疗有反应者（96.2%）在2年时康复的可能性显著高于部分有反应者或无反应者（79.1%）（P <.001），但与接受了最有效短期治疗（氟西汀和认知行为疗法联合）无关。在189名康复的参与者中，88名（46.6%）复发。完全短期治疗反应或原始治疗并不能预测复发。然而，完全或部分有反应者复发的可能性（42.9%）低于无反应者（67.6%）（P =.03）。性别可预测复发（女性为57.0%，男性为32.9%；P =.02）。
几乎所有抑郁的青少年都康复了。然而，几乎一半康复的青少年会复发，在这个年龄范围内女性复发的可能性更高。进一步的研究应该识别并解决年轻女性中更常见的复发易感性问题。
