Department of Psychiatry and Psychotherapy, University Medical Centre of the Johannes-Gutenberg-University Mainz, Untere Zahlbacher Str. 8, Germany.
Neuropharmacology. 2012 Jan;62(1):264-9. doi: 10.1016/j.neuropharm.2011.07.017. Epub 2011 Jul 22.
In Major Depressive Disorder, a growing data base suggests that the onset of antidepressants' action can be detected by improvement of depressive symptoms in the first 10-14 days of treatment. Previous studies showed that the mean concentration of the brain-derived neurotrophic factor (BDNF) in blood increases during antidepressant treatment and positively correlates with amelioration of MDD symptoms. We previously showed an association between very early changes of the serum BDNF concentration and treatment outcome (Tadić et al., 2011. Prog Neuropsychopharmacol Biol Psychiatry 35, 415-420). However, no study has yet investigated whether BDNF concentration in plasma increases in the early course of treatment and enables the prediction of final treatment outcome. The goal of this study was to investigate in MDD patients, whether the change of pBDNF in the early course of treatment is a specific and sensitive marker for final treatment outcome. For this purpose, we performed a naturalistic pilot study with 39 inpatients with MDD according to DSM-IV. Depression severity and pBDNF were measured in weekly intervals from baseline (EP) to endpoint (EP, max. week six) with the 21-item Hamilton Depression Rating Scale (HAMD-21) and enzyme-linked immunosorbent assay (ELISA), respectively. According to ROC-analysis, the best cut-off value for the prediction of response at EP is an increase of 338 pg/ml or 126%, respectively, of pBDNF between BL and day 7. The single markers pBDNF change and HAMD-21 improvement from BL-d7 predicted later treatment outcome with moderate to high sensitivity and specificity (pBDNF: 42% and 96%, resp.; HAMD improvement: 83% and 65%, resp.). The combined marker early pBDNF change plus HAMD-21 improvement at day 7 increased the specificity for response to 100%. Our data provide first preliminary evidence that an early change of pBDNF in conjunction with early improvement might be a peripheral marker predictive for treatment outcome in patients with MDD. This has to be confirmed in further investigations. This article is part of a Special Issue entitled 'Anxiety and Depression'.
在重度抑郁症中，越来越多的研究数据表明，抗抑郁药的作用可以通过治疗的前 10-14 天内抑郁症状的改善来检测。之前的研究表明，在抗抑郁治疗过程中，血液中脑源性神经营养因子（BDNF）的平均浓度增加，并且与 MDD 症状的改善呈正相关。我们之前曾表明，血清 BDNF 浓度的早期变化与治疗结果之间存在关联（Tadić 等人，2011.《神经精神药理学与生物精神病学进展》35，415-420）。然而，目前尚无研究探讨在治疗早期是否血浆 BDNF 浓度增加，并能预测最终的治疗结果。本研究的目的是在 MDD 患者中探讨，在治疗早期 pBDNF 的变化是否是最终治疗结果的特异性和敏感标志物。为此，我们根据 DSM-IV 对 39 名住院 MDD 患者进行了自然主义的初步研究。采用 21 项汉密尔顿抑郁评定量表（HAMD-21）和酶联免疫吸附试验（ELISA）分别在每周间隔（EP）从基线（EP）到终点（EP，最大第六周）测量抑郁严重程度和 pBDNF。根据 ROC 分析，预测 EP 时反应的最佳截断值是 pBDNF 在 BL 和第 7 天之间的增加量为 338pg/ml 或 126%。单独的 pBDNF 变化和 HAMD-21 从 BL-d7 的改善预测了后来的治疗结果，具有中等到高的敏感性和特异性（pBDNF：42%和 96%，分别；HAMD 改善：83%和 65%，分别）。第 7 天的早期 pBDNF 变化加上 HAMD-21 改善的联合标志物使对反应的特异性提高到 100%。我们的数据首次提供了初步证据，表明 MDD 患者中 pBDNF 的早期变化与早期改善相结合可能是治疗结果的外周标志物。这需要在进一步的研究中得到证实。本文是题为“焦虑和抑郁”的特刊的一部分。
