Department of Psychiatry, Harbor-UCLA Medical Center, Torrance, CA, USA.
Psychiatr Serv. 2011 Oct;62(10):1167-79. doi: 10.1176/ps.62.10.pss6210_1167.
The investigators examined whether outcomes differ by race-ethnicity for patients with major depressive disorder in acute- (12 weeks) and continuation-phase (weeks 12-28) treatment with one of two antidepressant combinations or one selective serotonin reuptake inhibitor.
This single-blind, seven-month prospective, randomized trial enrolled 352 non-Hispanic white (59%), 169 black (28%), and 79 white Hispanic (13%) participants from six primary and nine psychiatric care U.S. sites. Patients had nonpsychotic chronic or recurrent major depressive disorder (or both) of at least moderate severity. Escitalopram plus placebo, bupropion sustained-release plus escitalopram, or venlafaxine extended-release plus mirtazapine were delivered according to measurement-based care. The primary outcome was remission (last two consecutive 16-item Quick Inventory of Depressive Symptomatology-Self-Report ratings <8 and <6); secondary outcomes included side effects, adverse events, quality of life, function, and attrition.
Black participants had greater baseline psychiatric and medical comorbidity. Baseline depression severity did not significantly differ between groups. In both phases more blacks than those in other groups exited the trial early. There were only minor differences in side effects, no significant differences in remission rates, and no significant differences between groups in other outcomes for each treatment.
Despite differences in sociodemographic characteristics and comorbidities, when measurement-based care was used, members of different minority groups had similar outcomes when treated with one antidepressant or a combination of two antidepressants. Black participants had the highest attrition rate, an important issue to address in clinical care.
研究人员考察了在接受两种抗抑郁药联合治疗或一种选择性 5-羟色胺再摄取抑制剂治疗的急性期（12 周）和延续期（12-28 周）的重度抑郁障碍患者中，种族和民族差异是否会影响结局。
这项单盲、为期 7 个月的前瞻性、随机试验在六个初级保健和九个美国精神科护理点纳入了 352 名非西班牙裔白人（59%）、169 名黑人（28%）和 79 名西班牙裔白人（13%）参与者。患者患有非精神病性慢性或复发性重度抑郁障碍（或两者兼有），且病情至少为中度严重。根据基于测量的护理方案，给予艾司西酞普兰+安慰剂、安非他酮缓释片+艾司西酞普兰或文拉法辛缓释片+米氮平。主要结局是缓解（最后两次连续的 16 项抑郁症状自评量表-自我报告评分<8 和<6）；次要结局包括副作用、不良事件、生活质量、功能和脱落率。
黑人参与者有更多的基线精神和医学合并症。各组间基线抑郁严重程度无显著差异。在两个阶段，黑人参与者比其他组更早退出试验。每种治疗的副作用差异较小，缓解率无显著差异，各组间其他结局也无显著差异。
尽管存在社会人口学特征和合并症方面的差异，但在采用基于测量的护理时，不同少数族裔群体在接受一种抗抑郁药或两种抗抑郁药联合治疗时的结局相似。黑人参与者的脱落率最高，这是临床护理中需要解决的一个重要问题。
