Shiroma Paulo R, Thuras Paul, Johns Brian, Lim Kelvin O
Mental Health Service Line, Minneapolis VA Medical Center, Minneapolis, MN, USA; Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA.
Int J Geriatr Psychiatry. 2014 Nov;29(11):1132-9. doi: 10.1002/gps.4104. Epub 2014 Apr 4.
In subjects with depression, exposure to antidepressants improves recognition of positive emotions. This phenomenon, which occurs early in the course of treatment, has been proposed as the initial step in the mechanism of action to subsequent therapeutic effects of antidepressants. To this date, it has not been well examined among older depressed patients.
Older subjects with non-psychotic major depressive disorder were treated with citalopram in an 8-week open-label study. The main predictor of response and remission was the change in emotion recognition between baseline and day 7. Covariates included executive functions, baseline anxiety level, medical comorbidity, level of subjective stress, serum citalopram level, and level of social support.
Twenty-seven patients were considered for final analysis. Overall, accuracy of emotion recognition significantly improved between baseline (75%) and day 7 (83%) (X(2) = 34.50, df = 1, p < 0.001). Improvement to identify happy expressions occurred at 25% and 50% intensity with ceiling effect at 0%, 75%, and 100%. Change in emotion processing was marginally significant in predicting antidepressant response at day 56. Multivariate analysis showed that emotion processing is a significant predictor of response and remission when considered along with perceived level of social support.
Recognition of mildly intense happy expression, which improved early in the course of citalopram treatment, predicts subsequent antidepressant response and remission when considered along with perception of social support. Further studies would be necessary to examine specific neural substrates in the affective network involved in the acute therapeutic action of antidepressant in late-life depression.
在抑郁症患者中，服用抗抑郁药可改善对积极情绪的识别。这种现象在治疗过程早期出现，被认为是抗抑郁药后续治疗效果作用机制的初始步骤。迄今为止，在老年抑郁症患者中尚未得到充分研究。
在一项为期8周的开放标签研究中，使用西酞普兰治疗患有非精神病性重度抑郁症的老年受试者。反应和缓解的主要预测指标是基线和第7天之间情绪识别的变化。协变量包括执行功能、基线焦虑水平、合并症、主观压力水平、血清西酞普兰水平和社会支持水平。
27例患者纳入最终分析。总体而言，情绪识别准确率在基线时（75%）和第7天（83%）之间显著提高（X(2) = 34.50，自由度 = 1，p < 0.001）。识别快乐表情的改善出现在25%和50%强度时，在0%、75%和100%强度时出现天花板效应。在预测第56天的抗抑郁反应时，情绪处理的变化具有边缘显著性。多变量分析表明，当与感知到的社会支持水平一起考虑时，情绪处理是反应和缓解的显著预测指标。
在西酞普兰治疗过程早期改善的对轻度强烈快乐表情的识别，与社会支持感知一起考虑时，可预测后续抗抑郁反应和缓解。有必要进行进一步研究，以检查参与老年抑郁症抗抑郁药急性治疗作用的情感网络中的特定神经基质。
