Bell D Stewart, Shipman W Mark, Cleves Mario A, Siegelman Jill
Ontario Mental Health Department, Kaiser Permanente, Fontana Medical Center, Ontario, CA United States.
Clin Pract Epidemiol Ment Health. 2013 Jul 12;9:142-7. doi: 10.2174/1745017901309010142. Print 2013.
This paper proposes that a certain premorbid personality type - that of hard driving, achievement-oriented, often exercise-oriented individuals - correlates with bupropion response; conversely, patients without these premorbid traits and whose depression is marked by mood swings, irritability and rumination are likely fluoxetine responders. The authors developed the Fluoxetine Bupropion Assessment Scale (FBAS), a 10-question, self-administered rating scale, to assess these traits and hypothesized that its use would improve outcomes. A Marriage and Family Therapist (MFT) and a Registered Nurse/Nurse Practitioner (RN/NP) retrospectively reviewed 72 charts from one psychiatrist's office for two time periods: before and after the psychiatrist utilized the questionnaire to guide antidepressant selection (33 charts before and 39 charts after). Raters were blinded to the theory and to the treatment time period. On the basis of clinical information in the charts, they formulated Clinical Global Impression assessments of treatment response in patients with Beck Depression Inventory scores ≥17 who were not on either drug at the time of intake, and who were prescribed either fluoxetine or bupropion. The data were in the direction of better results in the FBAS-guided group, particularly after adjusting for age, gender and marital status (efficacy p = 0.087). When global improvement data were combined into three groups describing treatment response (improved, minimal to no improvement, and worse) there were statistically significant better results (p = 0.047) in the FBAS-guided treatment group. Revision and validation of the questionnaire and a larger, randomized study seem indicated.
本文提出，某种病前人格类型——即争强好胜、成就导向型，且常以运动为导向的个体——与安非他酮的反应相关；相反，没有这些病前特征且抑郁症以情绪波动、易怒和反复思考为特征的患者可能是氟西汀的反应者。作者开发了氟西汀安非他酮评估量表（FBAS），这是一个包含10个问题的自评量表，用于评估这些特征，并假设使用该量表会改善治疗结果。一名婚姻与家庭治疗师（MFT）和一名注册护士/执业护士（RN/NP）回顾性地查阅了一位精神科医生办公室在两个时间段的72份病历：在该精神科医生使用该问卷指导抗抑郁药选择之前和之后（之前33份病历，之后39份病历）。评分者对该理论和治疗时间段不知情。根据病历中的临床信息，他们对贝克抑郁量表得分≥17、在入院时未服用任何一种药物且被开了氟西汀或安非他酮的患者的治疗反应进行了临床总体印象评估。数据显示在FBAS指导组中有更好的结果趋势，尤其是在对年龄、性别和婚姻状况进行调整之后（疗效p = 0.087）。当将总体改善数据合并为描述治疗反应的三组（改善、轻微改善或无改善、恶化）时，FBAS指导治疗组有统计学上显著更好的结果（p = 0.047）。似乎需要对该问卷进行修订和验证，并开展一项更大规模的随机研究。
