Depression Clinical and Research Program at Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
Depress Anxiety. 2011 Feb;28(2):137-44. doi: 10.1002/da.20768. Epub 2010 Dec 13.
Many patients with major depressive disorder (MDD) who achieve full remission after antidepressant treatment still have residual depressive symptoms. In this study, we assess the type and frequency of residual symptoms and their relationship to subsequent depressive relapses after remission of major depression with fluoxetine.
Five hundred seventy-six patients with MDD were openly treated with fluoxetine for 12 weeks. Those who responded underwent random assignment, under double-blind conditions, to continue taking fluoxetine or to switch to placebo for 52 weeks or until relapse. The presence of residual symptoms in patients who achieved remission at the end of the acute phase (N=203) was assessed using the 28-item Hamilton Depression Rating Scale. Survival analysis was used to examine the effect of residual symptoms on relapse in remitters.
More than 90% of patients who met criteria for remission had at least one residual depressive symptom (median=4). The most common were sleep disturbances (insomnia 48.2%, hypersomnia 35.9%) and anxiety (52.7%). The most common individual symptom was middle insomnia (33.5%). No statistically or clinically significant differences in baseline variables were found between remitters with and without residual symptoms. The presence of residual symptoms, the presence of residual insomnia and the global number of residual symptoms did not predict relapse during the continuation phase of the study.
The great majority of patients with remission of MDD after treatment with fluoxetine continue to experience selected residual depressive symptoms. The presence of residual symptoms is not significantly associated with an increased risk of relapse.
许多在抗抑郁治疗后达到完全缓解的重度抑郁症（MDD）患者仍存在残留的抑郁症状。在这项研究中，我们评估了氟西汀治疗缓解后的残留症状的类型和频率及其与随后抑郁复发的关系。
576 名 MDD 患者接受氟西汀开放性治疗 12 周。对那些有反应的患者进行随机分组，双盲条件下继续服用氟西汀或转换为安慰剂治疗 52 周或直至复发。使用 28 项汉密尔顿抑郁量表评估在急性阶段结束时达到缓解的患者（n=203）中残留症状的存在。生存分析用于检查残留症状对缓解者复发的影响。
超过 90%符合缓解标准的患者存在至少一种残留的抑郁症状（中位数=4）。最常见的是睡眠障碍（失眠 48.2%，嗜睡 35.9%）和焦虑（52.7%）。最常见的单个症状是中度失眠（33.5%）。在缓解者和无残留症状者之间，基线变量没有统计学或临床意义上的差异。残留症状的存在、残留失眠的存在和残留症状的总数并未预测研究延续阶段的复发。
氟西汀治疗缓解后的 MDD 患者中，绝大多数仍存在特定的残留抑郁症状。残留症状的存在与复发风险增加无关。
