King's College London, Institute of Psychiatry, Department of Psychological Medicine, Affective Disorders Research Group, Box P074, 103 Denmark Hill, SE5 8AF, London, UK.
Psychiatry Res. 2013 May 30;207(3):143-9. doi: 10.1016/j.psychres.2013.03.022. Epub 2013 Apr 17.
Little is currently known about the long-term course of symptom severity and fluctuation in patients with treatment-resistant depression (TRD). We assessed this using the longitudinal interval follow-up evaluation in 115 patients with TRD (84 unipolar, 31 bipolar) with 1-7 years (median 36 months) of follow-up. Of the follow-up months, 39.2% were spent asymptomatic and 21.1% at sub-threshold symptom level, while 15.8% were spent at mild, 13.9% at moderate, and 10.0% at severe depressive episode level. Significantly more unipolar than bipolar patients were continuously symptomatic during follow-up (43% vs. 29%). Patients had a mean of 1.0 (S.D.=1.2) symptom severity level fluctuations per year. High fluctuating patients had significantly poorer global functioning and quality of life. Although most patients with TRD achieve an asymptomatic state, they continue to fluctuate and experience depressive symptoms in the majority of months, mostly at subclinical or mild severity. However, there are important differences between unipolar and bipolar TRD, with unipolar patients more likely to experience an unremitting depressive state. Additionally, a more fluctuating longitudinal illness course is associated with poorer function and quality of life, and with a bipolar diagnosis. We suggest that the longitudinal illness course is an important outcome to be considered in future TRD research.
目前对于治疗抵抗性抑郁症（TRD）患者的症状严重程度和波动的长期病程知之甚少。我们使用 115 例 TRD 患者（84 例单相，31 例双相）的纵向间隔随访评估来评估这一点，随访时间为 1-7 年（中位数 36 个月）。在随访的月份中，39.2%处于无症状状态，21.1%处于亚阈值症状水平，15.8%处于轻度抑郁，13.9%处于中度抑郁，10.0%处于重度抑郁发作水平。在随访期间，单相患者比双相患者持续出现症状的比例明显更高（43%对 29%）。患者每年的平均症状严重程度波动为 1.0（标准差=1.2）。波动较大的患者整体功能和生活质量明显较差。尽管大多数 TRD 患者达到无症状状态，但他们在大多数月份仍会出现波动和抑郁症状，主要处于亚临床或轻度严重程度。然而，单相和双相 TRD 之间存在重要差异，单相患者更有可能出现持续的抑郁状态。此外，纵向疾病过程的波动性更大与功能和生活质量较差以及双相诊断有关。我们建议，纵向疾病过程是未来 TRD 研究中需要考虑的一个重要结果。
