The Brain Institute, University of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, USA.
J Affect Disord. 2011 Dec;135(1-3):354-61. doi: 10.1016/j.jad.2011.07.010. Epub 2011 Aug 9.
Adolescent major depressive disorder (MDD) is a life-threatening brain disease with limited interventions. Treatment resistance is common, and the illness burden is disproportionately borne by females. 31-Phosphorus magnetic resonance spectroscopy ((31)P MRS) is a translational method for in vivo measurement of brain energy metabolites.
We recruited 5 female adolescents who had been on fluoxetine (Prozac®) for ≥ 8 weeks, but continued meet diagnostic criteria for MDD with a Children's Depression Rating Scale-Revised (CDRS-R) raw score ≥ 40. Treatment response was measured with the CDRS-R. (31)P MRS brain scans were performed at baseline, and repeated following adjunctive creatine 4 g daily for 8 weeks. For comparison, 10 healthy female adolescents underwent identical brain scans performed 8 weeks apart.
The mean CDRS-R score declined from 69 to 30.6, a decrease of 56%. Participants experienced no Serious Adverse Events, suicide attempts, hospitalizations or intentional self-harm. There were no unresolved treatment-emergent adverse effects or laboratory abnormalities. MDD participants' baseline CDRS-R score was correlated with baseline pH (p=0.04), and was negatively correlated with beta-nucleoside triphosphate (β-NTP) concentration (p=0.03). Compared to healthy controls, creatine-treated adolescents demonstrated a significant increase in brain Phosphocreatine (PCr) concentration (p=0.02) on follow-up (31)P MRS brain scans.
Lack of placebo control; and small sample size.
Further study of creatine as an adjunctive treatment for adolescents with SSRI-resistant MDD is warranted.
青少年重度抑郁症（MDD）是一种危及生命的脑部疾病，干预手段有限。治疗抵抗较为常见，且疾病负担不成比例地由女性承担。31 磷磁共振波谱（(31)P MRS）是一种用于活体测量脑能量代谢物的转化方法。
我们招募了 5 名接受氟西汀（百忧解®）治疗≥8 周但仍符合 MDD 诊断标准的女性青少年，其儿童抑郁评定量表修订版（CDRS-R）原始评分≥40。以 CDRS-R 来衡量治疗反应。在基线时进行（31）P MRS 脑部扫描，然后在 8 周内每天补充 4g 肌酸后重复进行扫描。为了进行比较，10 名健康的女性青少年接受了相隔 8 周的相同脑部扫描。
CDRS-R 评分从 69 分降至 30.6 分，下降了 56%。参与者没有发生严重不良事件、自杀企图、住院或故意自残。没有未解决的治疗中出现的不良影响或实验室异常。MDD 参与者的基线 CDRS-R 评分与基线 pH 值相关（p=0.04），与β-核苷三磷酸（β-NTP）浓度呈负相关（p=0.03）。与健康对照组相比，接受肌酸治疗的青少年在后续（31）P MRS 脑部扫描中大脑磷酸肌酸（PCr）浓度显著增加（p=0.02）。
缺乏安慰剂对照；样本量小。
需要进一步研究肌酸作为 SSRI 抵抗性 MDD 青少年的辅助治疗方法。
