Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Department of Pediatrics, Children's Hospital, Los Angeles, California, USA.
J Clin Psychiatry. 2017 Jul;78(7):897-903. doi: 10.4088/JCP.16m11335.
Major depressive disorder (MDD) can substantially worsen patient-reported quality of life (QOL) and functioning. Prior studies have examined the role of age in MDD by comparing depressive symptom severity or remission rates between younger and older adults. This study examines these outcomes before and after SSRI treatment. On the basis of prior research, we hypothesized that older adults would have worse treatment outcomes in QOL, functioning, and depressive symptom severity and that nonremitters would have worse outcomes.
A retrospective secondary data analysis was conducted from the National Institute of Mental Health-funded Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study (July 2001-September 2006). We analyzed data for 2,280 nonpsychotic adults with DSM-IV-TR-defined MDD who received citalopram monotherapy. Older adults were classified as adults aged 65 years and above. All subjects completed patient-reported QOL, functioning, and depressive symptom severity measures at entry and exit. Subjects included 106 older adults and 2,174 adults < 65. MDD remission status posttreatment was also determined.
Both older adults and adults < 65 experienced significant improvements and medium to large treatment responses across QOL, functioning, and depressive symptom severity (P < .001). Older adults had smaller treatment effect sizes for all outcomes, particularly functioning. Conversely, mean change scores from entry to exit were equivalent across all outcomes. Remitters at exit had significantly better responses to treatment than nonremitters for the majority of outcomes.
Findings suggest that older adults and younger adults have comparable treatment responses to citalopram monotherapy, with significant improvements in patient-reported depressive symptom severity, functioning, and QOL.
ClinicalTrials.gov identifier: NCT00021528.
重度抑郁症（MDD）会显著降低患者报告的生活质量（QOL）和功能。先前的研究通过比较年轻和老年成年人的抑郁症状严重程度或缓解率来研究年龄在 MDD 中的作用。本研究在 SSRI 治疗前后检查了这些结果。基于先前的研究，我们假设老年人在 QOL、功能和抑郁症状严重程度方面的治疗结果更差，并且未缓解者的结果更差。
对国立心理健康研究所资助的缓解抑郁的序贯治疗替代选择（STAR*D）研究（2001 年 7 月至 2006 年 9 月）的回顾性二次数据分析。我们分析了 2280 名符合 DSM-IV-TR 定义的 MDD 的非精神病成年人接受西酞普兰单药治疗的数据。老年人被定义为 65 岁及以上的成年人。所有患者在入组和出组时都完成了患者报告的 QOL、功能和抑郁症状严重程度的测量。受试者包括 106 名老年人和 2174 名 65 岁以下的成年人。还确定了治疗后 MDD 的缓解状态。
老年人和 65 岁以下成年人在 QOL、功能和抑郁症状严重程度方面均经历了显著的改善和中等至大的治疗反应（P<.001）。所有结果的治疗效果大小，尤其是功能，老年人都较小。相反，从入组到出组的平均变化分数在所有结果中均相等。出组时的缓解者在大多数结果方面对治疗的反应明显优于未缓解者。
研究结果表明，老年患者和年轻患者对西酞普兰单药治疗有相似的反应，患者报告的抑郁症状严重程度、功能和 QOL 均有显著改善。
ClinicalTrials.gov 标识符：NCT00021528。
