Department of Psychiatry & Psychotherapy, University Medical Center Mainz, Mainz, Germany.
Pharmacopsychiatry. 2013 Nov;46(7):261-6. doi: 10.1055/s-0033-1354370. Epub 2013 Sep 24.
Post hoc analyses of clinical trials have shown that early improvement around day 14 is highly predictive for later response. More-over, evidence has been given that sufficiently high concentrations of antidepressant drugs in blood are required to attain response. In this study, we determined cut-off levels for citalopram serum concentrations and clinical improvement during the early phase of treatment to predict later response and the predictive power of these measures either alone or in combination.
Inpatients with depressive disorder according to ICD-10 who received citalopram were included. Psychopathology was assessed by the 17-item Hamilton Depression (HAMD-17) rating scale, and serum concentrations of citalopram were measured in weekly intervals.
The analysis included 55 inpatients. Receiver operating characteristics analysis revealed for citalopram a serum concentration of 53 ng/ml on day 7 and a clinical improvement of 24% on the HAMD-17 scale on day 14 as significant cut-off values to predict response after 5 weeks of treatment. Both measures taken together predicted response on week 5 with 73% sensitivity and 85% specificity with an odds ratio of 14.6.
It is concluded that treatment with citalopram should be guided by symptom rating at baseline and on day 14 and serum concentration determination on day 7.
临床试验的事后分析表明，第 14 天左右的早期改善对后期反应具有高度预测性。此外，有证据表明，血液中抗抑郁药的浓度需要足够高才能达到反应。在这项研究中，我们确定了西酞普兰血清浓度和治疗早期临床改善的截止水平，以预测后期反应以及这些措施单独或联合使用的预测能力。
纳入根据 ICD-10 诊断为抑郁症的住院患者，接受西酞普兰治疗。通过 17 项汉密尔顿抑郁量表（HAMD-17）评估精神病理学，每周测量一次西酞普兰的血清浓度。
分析包括 55 名住院患者。受试者工作特征分析显示，第 7 天西酞普兰血清浓度为 53ng/ml，第 14 天 HAMD-17 量表的临床改善为 24%，是预测治疗 5 周后反应的显著截止值。这两个指标一起预测第 5 周的反应，灵敏度为 73%，特异性为 85%，优势比为 14.6。
结论是西酞普兰的治疗应根据基线和第 14 天的症状评分以及第 7 天的血清浓度测定来指导。
