Department of Biomedical and NeuroMotor Sciences, University of Bologna, Italy.
J Psychiatr Res. 2013 Oct;47(10):1309-18. doi: 10.1016/j.jpsychires.2013.05.020. Epub 2013 Jun 22.
Early antidepressant response (2nd week) has been reported as the result of a true antidepressant effect and a predictor of subsequent stable response. With the purpose to study the clinical profile of early response/remission (2nd week) compared to late response/remission (4th-6th weeks), two independent major depressive disorder (MDD) samples (the Sequenced Treatment Alternatives to Relieve Depression or STARD n=1922 and an Italian sample n=171) were investigated. Patients were treated with citalopram in the STARD while in a naturalistic setting in the Italian sample. Depressive symptomatology was assessed by the Hamilton Depressive Rating Scale weekly in the Italian sample and biweekly by the Quick Inventory of Depressive Symptomatology Clinician Rated in the STARD. Logistic regression was used to investigate possible predictors of early response and the Bonferroni correction was applied. In the STARD, higher levels of baseline core depressive symptoms (Bech subscale) were associated with early response (p=0.00017), as well as lower baseline insomnia (p=0.003) and higher work and social functioning (p=0.001). In the Italian sample none of these variables were associated with the phenotype, but a non significant trend of lower baseline quality of life (p=0.078) was observed in late remitters. In the STAR*D late responders reported higher levels of antidepressant induced side effects, especially difficulty in sleeping (p=5.68e-13), with a non significant trend in the same direction in the Italian sample (p=0.09). The identification of late versus early antidepressant responders at the beginning of the treatment may be useful to guide therapeutic choices in clinical settings.
早期抗抑郁反应（第 2 周）被报道为真正的抗抑郁作用的结果，也是随后稳定反应的预测指标。为了研究与晚期反应/缓解（第 4-6 周）相比的早期反应/缓解（第 2 周）的临床特征，研究人员调查了两个独立的重度抑郁症（MDD）样本（序贯治疗选择以缓解抑郁或 STARD n=1922 和一个意大利样本 n=171）。在 STARD 中，患者接受西酞普兰治疗，而在意大利样本中则在自然环境中接受治疗。抑郁症状通过 Hamilton 抑郁评定量表每周评估在意大利样本中，而在 STARD 中每两周由 Quick Inventory of Depressive Symptomatology Clinician Rated 评估。使用逻辑回归来研究早期反应的可能预测因素，并应用 Bonferroni 校正。在 STARD 中，基线核心抑郁症状（Bech 子量表）水平较高与早期反应相关（p=0.00017），基线失眠程度较低（p=0.003）和工作和社会功能较高（p=0.001）。在意大利样本中，这些变量均与表型无关，但晚期缓解者的基线生活质量较低（p=0.078）呈非显著趋势。在 STAR*D 中，晚期反应者报告了更高水平的抗抑郁药引起的副作用，尤其是睡眠困难（p=5.68e-13），意大利样本中也存在类似的非显著趋势（p=0.09）。在治疗开始时识别晚期与早期抗抑郁反应者可能有助于指导临床环境中的治疗选择。
