Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands.
Eur Neuropsychopharmacol. 2011 Mar;21(3):241-7. doi: 10.1016/j.euroneuro.2010.11.004. Epub 2010 Dec 13.
Knowledge on mechanisms involved in early prediction of response to antidepressant medication may help optimize clinical decision making. Recent studies regarding response to pharmacotherapy implicate resilience-like mechanisms and involvement of positive, rather than negative emotions. The aim of the current study is to examine the contribution of early change in positive affect to the prediction of response to pharmacotherapy. Positive and negative emotions were measured at baseline and during the first week of pharmacotherapy, using experience sampling techniques. The association between early change in positive and negative emotions and severity of depressive symptoms at week six was examined in a sample of 49 depressed patients. The added benefits of measuring early change in positive emotions compared to early Hamilton Depression Rating Scale (HDRS) change alone were evaluated through model comparisons. Early improvement in positive affect during the first week of treatment predicted the continuous HDRS score (β=-0.64, p<0.001), response (50% reduction; OR=4.32, p<0.01), and remission (HDRS≤7; OR=9.29, p<0.001) at week six with moderate to large effect sizes. Effects of early change in negative emotions were only half as large and disappeared when evaluated simultaneously with early change in positive emotions. When early change in positive emotions was added to the models including early HDRS change only, all three models improved significantly. In conclusion, early change in positive rather than negative emotions best predicted response to treatment, supporting the notion that antidepressants activate resilience-like mechanisms. Moreover, monitoring of positive emotions in early stages of treatment may improve clinical decision making.
关于预测抗抑郁药物治疗反应的机制的知识可能有助于优化临床决策。最近关于药物治疗反应的研究表明，与韧性相关的机制以及积极情绪的参与，而不是消极情绪。本研究的目的是检验积极情绪的早期变化对药物治疗反应预测的贡献。使用经验抽样技术，在基线和药物治疗的第一周测量积极和消极情绪。在 49 名抑郁患者的样本中，检查了第六周时积极和消极情绪的早期变化与抑郁症状严重程度之间的关系。通过模型比较评估了与仅测量早期汉密尔顿抑郁评定量表（HDRS）变化相比，测量早期积极情绪变化的额外好处。治疗第一周的积极情绪早期改善预测了第六周的连续 HDRS 评分（β=-0.64，p<0.001）、反应（50%减轻；OR=4.32，p<0.01）和缓解（HDRS≤7；OR=9.29，p<0.001），具有中等至大的效应大小。早期消极情绪变化的影响只有一半，并且当与早期积极情绪变化同时评估时消失。当早期积极情绪变化被添加到仅包括早期 HDRS 变化的模型中时，所有三个模型都显著改善。总之，积极情绪的早期变化而不是消极情绪最能预测治疗反应，支持抗抑郁药激活类似韧性的机制的观点。此外，在治疗早期监测积极情绪可能会改善临床决策。
