Kai-Suan Psychiatric Hospital, Taiwan.
Clin J Pain. 2011 Nov-Dec;27(9):805-10. doi: 10.1097/AJP.0b013e3182201849.
Response to an antidepressant is frequently the main goal in treating depression. The purpose of this study was to identify predictor(s) of response to the antidepressant, fluoxetine.
One hundred thirty-one newly hospitalized patients with major depressive disorder received fluoxetine (20 mg/d) for 6 weeks. Symptom severity was assessed using the 17-item Hamilton Depression Rating Scale at weeks 0, 1, 2, 3, 4, and 6. Response was defined as a reduction of ≥50% of the 17-item Hamilton Depression Rating Scale score. We compared the responders and nonresponders in terms of baseline variables. Pain measures included the Short-Form-36 (SF-36) pain severity score and pain interference score. Univariate logistic regression was used to identify variables associated with fluoxetine response.
A total of 66 (58.9%) of the 112 completers were classified as responders after a 6-week treatment. The responders and nonresponders did not differ in baseline variables, except melancholic features (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria) and pain measures (SF-36). SF-36 pain severity score had the smallest P value (P=0.015). Its odds ratio (0.70) means that each point increase in the score of pain severity is expected to decrease the chance of response by approximately 30%.
These findings from newly hospitalized patients with multiple pain measures support the previous studies, which enrolled mainly outpatients and found that a higher level of pain can have a strong negative impact on the antidepressant response. These data require confirmation and extension to outpatients and other antidepressants.
抗抑郁药治疗的主要目标通常是患者对药物的反应。本研究旨在确定预测氟西汀治疗反应的指标。
131 例新入院的重性抑郁障碍患者接受氟西汀（20mg/d）治疗 6 周。在第 0、1、2、3、4 和 6 周，使用汉密尔顿抑郁量表 17 项（Hamilton Depression Rating Scale，HDRS-17）评估症状严重程度。将减分率≥50%定义为有效。比较两组患者基线变量的差异。疼痛评估包括简明健康调查问卷（Short-Form-36，SF-36）疼痛严重度评分和疼痛干扰评分。使用单变量逻辑回归分析确定与氟西汀反应相关的变量。
112 例完成治疗的患者中，66 例（58.9%）被分类为有效。有效组和无效组在基线变量方面没有差异，除了忧郁特征（精神障碍诊断与统计手册第 4 版标准）和疼痛评估（SF-36）。SF-36 疼痛严重度评分的 P 值最小（P=0.015）。其比值比（odds ratio，OR）为 0.70，这意味着疼痛严重度评分每增加 1 分，反应的可能性预计会降低约 30%。
本研究采用多种疼痛评估方法，纳入了新入院的患者，结果与既往主要纳入门诊患者的研究一致，提示疼痛程度较高会对抗抑郁药的反应产生负面影响。这些数据有待于在门诊患者和其他抗抑郁药中进行验证和扩展。
