Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
Department of Psychiatry, Tachikawa Hospital, Tokyo, Japan.
J Clin Psychiatry. 2017 Feb;78(2):e146-e151. doi: 10.4088/JCP.15m10573.
The aim of this post hoc analysis was to evaluate which specific depressive items could predict subsequent durable recovery in patients with bipolar depression.
The study population was at least 18 years old and met DSM-IV criteria for a major depressive episode associated with either bipolar I or II disorder. The data were derived from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), in which patients with bipolar depression were randomly assigned to treatment for acute depression with a mood stabilizer plus an adjunctive antidepressant drug or placebo. The primary and secondary outcomes were durable recovery (ie, 8 consecutive weeks of euthymia) and treatment-emergent affective switch (ie, transition to mania or hypomania), respectively. Binary logistic regression analysis was performed to identify specific symptoms whose improvement during the first 2 weeks predicted those outcomes; the score change of each individual symptom in the continuous symptom subscales for depression (SUM-D) from week 0 to week 2 was used as an independent variable.
In the evaluable 188 participants who took placebo and active drugs, the improvement in loss of self-esteem (P = .037) or loss of energy (P = .040) at week 2 was significantly associated with higher chances of subsequent durable recovery. For participants taking active drugs (n = 91), solely the improvement in loss of energy at week 2 was significantly associated with subsequent durable recovery (P = .027). There was a significant association between the improvement of psychomotor retardation at week 2 and subsequent affective switch (P = .008).
These findings imply that focusing on individual symptoms is important in bipolar depression, rather than relying solely on a summed score in rating scales.
The original STEP-BD dataset is registered on ClinicalTrials.gov (identifier: NCT00012558).
本事后分析旨在评估哪些特定的抑郁项目能够预测双相情感障碍抑郁患者的后续持久缓解。
研究人群至少为 18 岁，符合 DSM-IV 标准，存在与双相 I 或 II 障碍相关的重性抑郁发作。数据来自双相情感障碍的系统性治疗强化项目（STEP-BD），其中双相情感障碍抑郁患者被随机分配接受心境稳定剂联合辅助抗抑郁药物或安慰剂治疗急性抑郁。主要和次要结局分别为持久缓解（即 8 周连续缓解）和治疗诱发的情感转换（即转为躁狂或轻躁狂）。采用二项逻辑回归分析来确定前 2 周改善能够预测这些结局的特定症状；抑郁连续症状亚量表（SUM-D）中每个个体症状的评分变化从第 0 周到第 2 周作为一个独立变量。
在接受安慰剂和活性药物的可评估 188 名参与者中，第 2 周自尊丧失（P=.037）或乏力改善（P=.040）与随后持久缓解的机会显著相关。对于服用活性药物的参与者（n=91），仅第 2 周乏力改善与随后持久缓解显著相关（P=.027）。第 2 周精神运动迟缓改善与随后的情感转换显著相关（P=.008）。
这些发现意味着在双相情感障碍抑郁中关注个体症状很重要，而不仅仅是依赖量表的总分。
原始 STEP-BD 数据集在 ClinicalTrials.gov 上注册（标识符：NCT00012558）。
