抗抑郁治疗史作为东莨菪碱反应的预测指标：临床意义
Antidepressant treatment history as a predictor of response to scopolamine: clinical implications.
作者信息
Ellis Jessica S, Zarate Carlos A, Luckenbaugh David A, Furey Maura L
机构信息
National Institutes of Health/National Institute of Mental Health,Experimental Therapeutics and Pathophysiology Branch, 10 Center Dr., Building 10/CRC, Room 7-5561, Bethesda, MD 20814-9692, USA.
National Institutes of Health/National Institute of Mental Health,Experimental Therapeutics and Pathophysiology Branch, 10 Center Dr., Building 10/CRC, Room 7-5561, Bethesda, MD 20814-9692, USA; National Institutes of Health/National Institute of Mental Health, Experimental Therapeutics and Pathophysiology Branch, 10 Center Dr., Building 10/CRC, Bethesda, MD, 20814-9692, USA.
出版信息
J Affect Disord. 2014 Jun;162:39-42. doi: 10.1016/j.jad.2014.03.010. Epub 2014 Mar 26.
BACKGROUND
The intravenous administration of scopolamine produces rapid antidepressant effects. Generally, failing multiple previous antidepressant trials is associated with a poor prognosis for response to future medications. This study evaluated whether treatment history predicts antidepressant response to scopolamine.
METHODS
Treatment resistant patients (2 failed medication trials) (n=31) and treatment naïve patients (no exposure to psychotropic medication) (n=31) with recurrent major depressive or bipolar disorder participated in a double-blind, placebo-controlled, crossover clinical trial. Following a placebo lead-in, participants randomly received P/S or S/P (P=3 placebo; S=3 scopolamine (4ug/kg) sessions 3 to 5 days apart). The Montgomery-Asberg Depression Rating Scale (MADRS) was the primary outcome measure. A linear mixed model was used to examine the interaction between clinical response and treatment history, adjusting for baseline MADRS.
RESULTS
Treatment resistant and treatment naïve subjects combined responded significantly to scopolamine compared to placebo (F=15.06, p<0.001). Reduction in depressive symptoms was significant by the first post-scopolamine session (F=42.75, p<0.001). A treatment history by scopolamine session interaction (F=3.37, p=0.04) indicated treatment naïve subjects had lower MADRS scores than treatment resistant patients; this was significant after the second scopolamine infusion (t=2.15, p=0.03).
LIMITATIONS
Post-hoc analysis: Also, we used a single regimen to administer scopolamine, and smokers were excluded from the sample, limiting generalizability.
CONCLUSIONS
Treatment naïve and treatment resistant patients showed improved clinical symptoms following scopolamine, while those who were treatment naïve showed greater improvement. Scopolamine rapidly reduces symptoms in both treatment history groups, and demonstrates sustained improvement even in treatment resistant patients.
背景
静脉注射东莨菪碱可产生快速抗抑郁作用。一般来说，之前多次抗抑郁试验失败与未来药物治疗反应的不良预后相关。本研究评估治疗史是否可预测对东莨菪碱的抗抑郁反应。
方法
患有复发性重度抑郁症或双相情感障碍的难治性患者（2次药物试验失败）（n = 31）和初治患者（未接触过精神药物）（n = 31）参与了一项双盲、安慰剂对照、交叉临床试验。在安慰剂导入期后，参与者随机接受P/S或S/P（P = 3次安慰剂；S = 3次东莨菪碱（4μg/kg），间隔3至5天）。蒙哥马利-阿斯伯格抑郁评定量表（MADRS）是主要结局指标。使用线性混合模型来检验临床反应与治疗史之间的相互作用，并对基线MADRS进行调整。
结果
与安慰剂相比难治性和初治受试者联合使用东莨菪碱有显著反应（F = 15.06，p < 0.001）。在首次东莨菪碱治疗后抑郁症状显著减轻（F = 42.75，p < 0.001）。治疗史与东莨菪碱治疗疗程的相互作用（F = 3.37，p = 0.04）表明初治受试者的MADRS评分低于难治性患者；在第二次东莨菪碱输注后差异显著（t = 2.
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