Sacchetti Emilio, Frank Ellen, Siracusano Alberto, Racagni Giorgio, Vita Antonio, Turrina Cesare
aDepartment of Clinical and Experimental Sciences, Brescia University School of Medicine bUniversity Psychiatric Unit, Department of Mental Health, Brescia Spedali Civili, Brescia cDepartment of Systems Medicine, University Tor Vergata, Rome dDepartment of Pharmacological and Biomolecular Sciences, University of Milano, Milano, Italy eDepartment of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Int Clin Psychopharmacol. 2015 May;30(3):129-41. doi: 10.1097/YIC.0000000000000074.
In recent years, the standard for successful treatment of major depression has switched from response to remission; however, little is known about patients who have achieved remission, but still have some residual symptoms and whether they regain previous levels of functioning. In a large, nationwide, cross-sectional, naturalistic survey (VIVAL-D) of 907 patients with major depression treated with a new course of an antidepressant in 41 Italian community psychiatric centers, patients with a Hamilton Rating Scale for Depression, 17-item version (HAM-D17) score up to 14 were selected (n=499). Of these, 169 were considered to be in remission (HAM-D17 ≤ 7) and the other 330 to be mildly depressed. Their level of functioning was evaluated using the SF-12. Only a few (3%) patients in remission were completely symptom free; most were affected by residual symptoms. Patients in remission had better SF-12 scores than those with mild depression, but their functioning was significantly worse than general population norms. In the logistic regression analysis, the HAM-D17 total score and individual items were predictive of poor functioning. Analysis of sensitivity and specificity values showed that a lower cut-off score (4/5) of the HAM-D17 scale was best for predicting poor performance so that a reconsideration of the usual cut-off for remission of 7/8 for HAM-D17 seems overdue.
近年来，重度抑郁症成功治疗的标准已从症状缓解转变为症状消失；然而，对于已实现症状消失但仍有一些残留症状的患者以及他们是否能恢复到之前的功能水平，我们知之甚少。在一项针对意大利41个社区精神病中心接受新疗程抗抑郁药治疗的907例重度抑郁症患者的大型全国性横断面自然主义调查（VIVAL-D）中，选择汉密尔顿抑郁量表17项版本（HAM-D17）评分高达14分的患者（n = 499）。其中，169例被认为症状消失（HAM-D17≤7），另外330例为轻度抑郁。使用SF-12评估他们的功能水平。只有少数（3%）症状消失的患者完全没有症状；大多数患者仍受残留症状影响。症状消失的患者SF-12评分优于轻度抑郁患者，但他们的功能明显比一般人群标准差。在逻辑回归分析中，HAM-D17总分和各个项目可预测功能不良。敏感性和特异性值分析表明，HAM-D17量表较低的截断分数（4/5）最能预测功能不良，因此似乎早就应该重新考虑HAM-D17通常7/8的症状消失截断分数了。
