Office of Clinical Sciences, Duke-NUS Graduate Medical School Singapore, Singapore.
Psychol Med. 2012 Jun;42(6):1131-49. doi: 10.1017/S0033291711002170. Epub 2011 Oct 19.
Major depressive disorder (MDD) is commonly chronic and/or recurrent. We aimed to determine whether a chronic and/or recurrent course of MDD is associated with acute and longer-term MDD treatment outcomes.
This cohort study recruited out-patients aged 18-75 years with non-psychotic MDD from 18 primary and 23 psychiatric care clinics across the USA. Participants were grouped as: chronic (index episode >2 years) and recurrent (n = 398); chronic non-recurrent (n=257); non-chronic recurrent (n=1614); and non-chronic non-recurrent (n = 387). Acute treatment was up to 14 weeks of citalopram (≤ 60 mg/day) with up to 12 months of follow-up treatment. The primary outcomes for this report were remission [16-item Quick Inventory of Depressive Symptomatology - Self-Rated (QIDS-SR(16)) ≤ 5] or response (≥ 50% reduction from baseline in QIDS-SR(16)) and time to first relapse [first QIDS-SR16 by Interactive Voice Response (IVR) ≥ 11].
Most participants (85%) had a chronic and/or recurrent course; 15% had both. Chronic index episode was associated with greater sociodemographic disadvantage. Recurrent course was associated with earlier age of onset and greater family histories of depression and substance abuse. Remission rates were lowest and slowest for those with chronic index episodes. For participants in remission entering follow-up, relapse was most likely for the chronic and recurrent group, and least likely for the non-chronic, non-recurrent group. For participants not in remission when entering follow-up, prior course was unrelated to relapse.
Recurrent MDD is the norm for out-patients, of whom 15% also have a chronic index episode. Chronic and recurrent course of MDD may be useful in predicting acute and long-term MDD treatment outcomes.
重度抑郁症（MDD）通常是慢性的和/或复发性的。我们旨在确定 MDD 的慢性和/或复发性病程是否与急性和长期 MDD 治疗结果相关。
这项队列研究招募了来自美国 18 家初级保健和 23 家精神科护理诊所的年龄在 18 至 75 岁之间的非精神病性 MDD 门诊患者。参与者被分为以下几组：慢性（指数发作>2 年）和复发性（n=398）；慢性非复发性（n=257）；非慢性复发性（n=1614）；和非慢性非复发性（n=387）。急性治疗为期 14 周的西酞普兰（≤60mg/天），随后进行长达 12 个月的随访治疗。本报告的主要结果是缓解[16 项贝克抑郁自评量表（BDI）-自我报告（BDI-SR（16））≤5]或反应（BDI-SR（16）基线降低≥50%）和首次复发时间[首次通过交互式语音应答（IVR）的 BDI-SR16≥11]。
大多数参与者（85%）具有慢性和/或复发性病程；15%的患者同时具有这两种病程。慢性指数发作与更大的社会人口劣势相关。复发性病程与更早的发病年龄以及更大的抑郁症和物质滥用家族史相关。具有慢性指数发作的患者缓解率最低，缓解速度最慢。对于进入随访期时缓解的参与者，慢性和复发性组最有可能复发，而非慢性、非复发性组最不可能复发。对于进入随访期时未缓解的参与者，既往病程与复发无关。
复发性 MDD 是门诊患者的常态，其中 15%的患者还存在慢性指数发作。MDD 的慢性和复发性病程可能有助于预测急性和长期 MDD 治疗结果。
