Danovitch Itai, Steiner Alexander Joseph, Kazdan Anna, Goldenberg Matthew, Haglund Margaret, Mirocha James, Collison Katherine, Vanle Brigitte, Dang Jonathan, IsHak Waguih William
Department of Psychiatry and Behavioral Neurosciences (ID, AJS, AK, MG, MH, BV, JD, WWI), Cedars-Sinai Medical Center; Department of Psychiatry and Biobehavioral Sciences (WWI), David Geffen School of Medicine, University of California; Department of Psychology (AJS), California School of Professional Psychology at Alliant International University; Biostatistics Core (JM), Research Institute and Clinical & Translational Science Institute (CTSI), Cedars-Sinai Medical Center, Los Angeles, CA; and Department of Psychological Sciences (KC), Purdue University, West Lafayette, IN.
J Addict Med. 2017 Jan/Feb;11(1):47-54. doi: 10.1097/ADM.0000000000000268.
Alcohol use disorders (AUDs) are common among persons with major depressive disorder (MDD) and have an adverse impact on course of illness and patient outcomes. The aim of this study was to examine whether AUD adversely impacted patient-centered outcomes in a sample of research subjects evaluated as part of a large clinical trial for depression. The outcomes of interest to this post hoc analysis are quality of life (QOL), functioning, and depressive symptom severity.
We analyzed 2280 adult MDD outpatient research subjects using data from the Sequenced Treatment Alternatives to Relieve Depression trial. We compared entry and post-selective serotonin reuptake inhibitors (SSRI) treatment QOL, functioning, and depressive symptom severity scores between 121comorbid MDD with AUD (MDD + AUD) subjects and 2159 MDD-no-AUD subjects, and also differences between subjects categorized as remitters versus nonremitters within each group at exit.
At entry, MDD + AUD subjects reported similar QOL, functioning, and depressive symptom severity compared with the MDD-no-AUD subjects. After treatment with citalopram, both groups showed significant improvements throughout treatment; however, 36% to 55% of subjects still suffered from severely impaired QOL and functioning at exit.
The overall study population demonstrated a significant response to treatment with large effect sizes in depressive symptom reduction, but to a lesser extent in QOL and functioning. Findings suggest that subjects with MDD + AUD benefited equally as MDD-no-AUD from treatment with selective serotonin reuptake inhibitors (SSRI) medication, yet both groups continue to experience reduced QOL and functioning after treatment. Monitoring QOL and functioning is critical to determine whether interventions that improve clinical outcomes also impact patient-centered outcomes, and our analysis suggests that there is a pressing need for innovative interventions that effectively improve these outcomes.
酒精使用障碍（AUDs）在重度抑郁症（MDD）患者中很常见，并且对疾病进程和患者预后有不利影响。本研究的目的是在作为抑郁症大型临床试验一部分进行评估的研究对象样本中，检验AUD是否对以患者为中心的预后产生不利影响。本次事后分析感兴趣的预后指标是生活质量（QOL）、功能状况和抑郁症状严重程度。
我们使用缓解抑郁症的序贯治疗方案试验的数据，对2280名成年MDD门诊研究对象进行了分析。我们比较了121名合并MDD与AUD（MDD+AUD）的受试者和2159名无AUD的MDD受试者在开始治疗时以及选择性5-羟色胺再摄取抑制剂（SSRI）治疗后的QOL、功能状况和抑郁症状严重程度评分，还比较了每组中在研究结束时分为缓解者与未缓解者的受试者之间的差异。
在开始治疗时，MDD+AUD受试者报告的QOL、功能状况和抑郁症状严重程度与无AUD的MDD受试者相似。在用西酞普兰治疗后，两组在整个治疗过程中均显示出显著改善；然而，36%至55%的受试者在研究结束时仍存在生活质量严重受损和功能障碍的情况。
总体研究人群对治疗表现出显著反应，在减轻抑郁症状方面效应量较大，但在生活质量和功能状况方面程度较小。研究结果表明，MDD+AUD受试者与无AUD的MDD受试者从选择性5-羟色胺再摄取抑制剂（SSRI）药物治疗中获益相当，但两组在治疗后生活质量和功能状况仍持续下降。监测生活质量和功能状况对于确定改善临床预后的干预措施是否也会影响以患者为中心的预后至关重要，并且我们的分析表明迫切需要能够有效改善这些预后的创新干预措施。
