Icick Romain, Millet Élodie, Curis Emmanuel, Bellivier Frank, Lépine Jean-Pierre
Service de Psychiatrie d׳Adultes du Pr F. Bellivier, AP-HP, Groupe Hospitalier Saint-Louis - Lariboisière - Fernand Widal, Paris, France; Inserm UMR-S 1144, Universités Paris Descartes - Paris Diderot, Paris, France.
Groupe Hospitalier Paul Guiraud, Villejuif, France.
J Affect Disord. 2014 Jun;161:127-35. doi: 10.1016/j.jad.2014.03.002. Epub 2014 Mar 18.
Major Depressive Disorder (MDD) is the 3rd source for burden worldwide according to the World Health Organization (WHO). This comes partly from unsatisfactory response rates after usual treatment, highlighting the need for early indicators such as early improvement of depressive symptoms to adapt treatment strategies, especially for severe inpatients. Thus our objective was to assess the predictive value of baseline partial resistance in early antidepressant response (EAR), hypothesizing that previous treatment failures would decrease the probability of early response.
We included 122 consecutive inpatients with current unipolar MDE. The Mini-Neuropsychiatric Interview was used to ascertain DSM-IV diagnoses of MDD as well as psychiatric comorbidities, and to exclude patients with a history of bipolar disorder. A specifically designed questionnaire was used to collect data on previous treatment trials for the current episode so as to generate scores on the five existing methods for quantifying treatment resistance. We prospectively assessed EAR, defined as a 50% decrease in MADRS after 14 days of steady regimen of antidepressant.
In the per protocol sample (N=76), multivariate analyses showed that psychotic features at baseline remained an independent predictor of absence of EAR (p<.01), unlike baseline partial resistance, which may rather be associated with a lack of any improvement.
Lack of data about further response and non-randomized treatment allocation.
Available methods for quantifying treatment resistance are heterogeneous and do not predict short-term response among severely depressed inpatients, despite potential usefulness in predicting a lack of early improvement.
根据世界卫生组织(WHO)的数据,重度抑郁症(MDD)是全球疾病负担的第三大来源。这部分源于常规治疗后的缓解率不尽人意,凸显了需要早期指标,如抑郁症状的早期改善,以调整治疗策略,尤其是对于重症住院患者。因此,我们的目标是评估基线部分抵抗在早期抗抑郁反应(EAR)中的预测价值,假设既往治疗失败会降低早期反应的可能性。
我们纳入了122例连续的当前患有单相重度抑郁发作的住院患者。使用迷你神经精神访谈来确定MDD的DSM-IV诊断以及精神共病情况,并排除有双相情感障碍病史的患者。使用专门设计的问卷收集关于当前发作既往治疗试验的数据,以便根据现有的五种量化治疗抵抗的方法生成评分。我们前瞻性地评估EAR,定义为在抗抑郁药稳定治疗14天后蒙哥马利-阿斯伯格抑郁量表(MADRS)得分降低50%。
在符合方案样本(N = 76)中,多变量分析显示,与基线部分抵抗不同,基线时的精神病性特征仍然是无EAR的独立预测因素(p <.01),基线部分抵抗可能反而与缺乏任何改善相关。
缺乏关于进一步反应和非随机治疗分配的数据。
现有的量化治疗抵抗的方法各不相同,并且不能预测重度抑郁住院患者的短期反应,尽管在预测缺乏早期改善方面可能有用。