Vogelzangs Nicole, Beekman Aartjan T F, van Reedt Dortland Arianne K B, Schoevers Robert A, Giltay Erik J, de Jonge Peter, Penninx Brenda W J H
1] Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands [2] Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
Neuropsychopharmacology. 2014 Jun;39(7):1624-34. doi: 10.1038/npp.2014.9. Epub 2014 Jan 20.
Scarce evidence suggests that inflammatory and metabolic dysregulation predicts poor response to antidepressants, which could result in worse depression outcome. This study prospectively examined whether inflammatory and metabolic dysregulation predicted the 2-year course of depressive disorders among antidepressant users. Data were from the Netherlands Study of Depression and Anxiety, including 315 persons (18-65 years) with a current depressive disorder (major depressive disorder, dysthymia) at baseline according to the DSM-IV criteria and using antidepressants. Inflammatory (C-reactive protein, interleukin-6 (IL-6), tumor-necrosis factor-α) and metabolic (waist circumference, triglycerides, high-density lipoprotein (HDL) cholesterol, blood pressure, fasting glucose) factors were measured at baseline. Primary outcome for course of depression was indicated by whether or not a DSM-IV depressive disorder diagnosis was still/again present at 2-year follow-up, indicating chronicity of depression. Elevated IL-6, low HDL cholesterol, hypertriglyceridemia, and hyperglycemia were associated with chronicity of depression in antidepressant users. Persons showing ⩾ 4 inflammatory or metabolic dysregulations had a 1.90 increased odds of depression chronicity (95% CI = 1.12-3.23). Among persons who recently (ie, at most 3 months) started antidepressant medication (N = 103), having ⩾ 4 dysregulations was associated with a 6.85 increased odds of depression chronicity (95% CI = 1.95-24.06). In conclusion, inflammatory and metabolic dysregulations were found to predict a more chronic course of depressive disorders among patients using antidepressants. This could suggest that inflammatory and metabolic dysregulation worsens depression course owing to reduced antidepressant treatment response and that alternative intervention treatments may be needed for depressed persons with inflammatory and metabolic dysregulation.
仅有少量证据表明，炎症和代谢失调预示着对抗抑郁药反应不佳，这可能导致更糟糕的抑郁结局。本研究前瞻性地检验了炎症和代谢失调是否能预测抗抑郁药使用者中抑郁障碍的2年病程。数据来自荷兰抑郁与焦虑研究，包括315名年龄在18至65岁之间、根据《精神疾病诊断与统计手册》第四版（DSM-IV）标准在基线时患有当前抑郁障碍（重度抑郁症、心境恶劣障碍）且正在使用抗抑郁药的患者。在基线时测量炎症（C反应蛋白、白细胞介素-6（IL-6）、肿瘤坏死因子-α）和代谢（腰围、甘油三酯、高密度脂蛋白（HDL）胆固醇、血压、空腹血糖）因素。抑郁病程的主要结局通过在2年随访时是否仍存在/再次出现DSM-IV抑郁障碍诊断来表明，这表明了抑郁的慢性化。IL-6升高、HDL胆固醇降低、高甘油三酯血症和高血糖与抗抑郁药使用者的抑郁慢性化相关。表现出≥4种炎症或代谢失调的人患抑郁慢性化的几率增加了1.90倍（95%置信区间=1.12 - 3.23）。在最近（即最多3个月）开始使用抗抑郁药的患者（N = 103）中，存在≥4种失调与抑郁慢性化几率增加6.85倍相关（95%置信区间=1.95 - 24.06）。总之，研究发现炎症和代谢失调可预测使用抗抑郁药的患者中抑郁障碍病程更慢性化。这可能表明，炎症和代谢失调由于抗抑郁治疗反应降低而使抑郁病程恶化，对于伴有炎症和代谢失调的抑郁症患者可能需要替代干预治疗。
