Office of Clinical Sciences, Duke-NUS Graduate Medical School Singapore, Singapore.
Psychol Med. 2013 May;43(5):945-60. doi: 10.1017/S0033291712001742. Epub 2012 Dec 11.
Prior studies have suggested that major depressive disorder (MDD) with pre-adult onset represents a distinct subtype with greater symptom severity and higher rates of suicidal ideation. Whether these patients have poorer response to various types of antidepressant treatment than those with adult-onset MDD is unclear. Method A total of 665 psychiatric and primary care out-patients (aged 18-75 years) with non-psychotic chronic or recurrent MDD participated in a single-blind, randomized trial that compared the efficacy of escitalopram plus placebo, bupropion sustained-release plus escitalopram, or venlafaxine extended-release plus mirtazapine. We compared participants who self-reported MDD onset (before age 18) to those with a later onset (adult onset) with respect to baseline characteristics and treatment/outcome variables at 12 and 28 weeks.
Early-onset chronic/recurrent MDD was associated with a distinct set of sociodemographic (female, younger age) and clinical correlates (longer duration of illness, greater number of prior episodes, greater likelihood of atypical features, higher rates of suicidality and psychiatric co-morbidity, fewer medical problems, poorer quality of life, greater history of child abuse/neglect). However, results from unadjusted and adjusted analyses showed no significant differences in response, remission, tolerability of medications, quality of life, or retention at 12 or 28 weeks.
Although early-onset chronic/recurrent MDD is associated with a more severe clinical picture, it does not seem to be useful for predicting differential treatment response to antidepressant medication. Clinicians should remain alert to an increased risk of suicidality in this population.
先前的研究表明，成年前发病的重度抑郁症（MDD）代表一种独特的亚型，其症状严重程度更高，自杀意念发生率更高。这些患者是否比成年发病的 MDD 患者对各种类型的抗抑郁治疗反应更差尚不清楚。方法：共有 665 名精神科和初级保健门诊患者（年龄 18-75 岁）患有非精神病性慢性或复发性 MDD，参加了一项单盲、随机试验，比较了艾司西酞普兰加安慰剂、安非他酮缓释片加艾司西酞普兰或文拉法辛缓释片加米氮平的疗效。我们比较了自我报告 MDD 发病（18 岁前）和晚发（成年发病）的患者在 12 周和 28 周时的基线特征和治疗/结局变量。结果：早发性慢性/复发性 MDD 与一系列特定的社会人口统计学（女性，年龄较小）和临床特征（更长的疾病持续时间、更多的既往发作、更有可能出现非典型特征、更高的自杀率和精神共病率、较少的医疗问题、较差的生活质量、更多的儿童期虐待/忽视史）相关。然而，未经调整和调整分析的结果显示，在 12 周或 28 周时，对药物的反应、缓解率、耐受性、生活质量或保留率没有显著差异。结论：尽管早发性慢性/复发性 MDD 与更严重的临床特征相关，但似乎不能用于预测抗抑郁药物治疗反应的差异。临床医生应警惕该人群自杀风险增加。
