Gobbi Gabriella, Ghabrash Maykel F, Nuñez Nicolas, Tabaka John, Di Sante Jessica, Saint-Laurent Marie, Vida Stephen, Kolivakis Theodore, Low Nancy, Cervantes Pablo, Booij Linda, Comai Stefano
Department of Psychiatry, Neurobiological Psychiatry Unit.
Department of Psychiatry, Mood Disorders Clinic, McGill University Health Center, McGill University.
Int Clin Psychopharmacol. 2018 Jan;33(1):34-43. doi: 10.1097/YIC.0000000000000196.
Patients with treatment-resistant unipolar depression (TRD) are treated with antidepressant combinations (ADs) or with second-generation antipsychotics plus AD (SGA+AD) augmentation; however, the clinical characteristics, the factors associated independently with response to SGA+AD, and the outcome trajectories have not yet been characterized. We performed a naturalistic study on the latest stable trial (medication unchanged for about 3 months) in 86 TRD patients with resistance to at least two ADs trials, who received ADs (n=36) or SGA+AD (n=50) treatments. Montgomery-Asberg Depression Rating Scale (MADRS), Hamilton-Depression Rating Scale (HAM-D17), and other scales were administered before (T0) and after the latest 3-month stable trial (T3). Compared to ADs, the SGA+AD group showed increased percentage of depression with psychotic features, comorbidity for personality disorders and substance use disorders (SUD), higher number of failed ADs pharmacotherapies and depressive symptoms at T0 on all scales (P<0.001). Compared to T0, both treatments significantly decreased depressive symptoms on MADRS and HAM-D17 at T3 (P<0.001); however, the SGA+AD augmentation produced a greater decline in mean score. Logistic regression analysis indicated that psychotic features, personality disorders, and SUD were independently associated with SGA+AD treatment. Given the greater improvement in depression following SGA+AD augmentation, SGA augmentation should be indicated as a first-line treatment in severe TRD with psychotic features, SUD, and personality disorders.
难治性单相抑郁症（TRD）患者采用抗抑郁药联合治疗（ADs）或第二代抗精神病药加抗抑郁药（SGA+AD）强化治疗；然而，其临床特征、与SGA+AD反应独立相关的因素以及结局轨迹尚未得到明确描述。我们对86例对至少两项ADs试验耐药的TRD患者进行了一项自然主义研究，这些患者接受了ADs（n=36）或SGA+AD（n=50）治疗，研究针对的是最新的稳定试验（药物治疗约3个月未改变）。在最新的3个月稳定试验之前（T0）和之后（T3），使用蒙哥马利-阿斯伯格抑郁评定量表（MADRS）、汉密尔顿抑郁评定量表（HAM-D17）和其他量表进行评估。与ADs相比，SGA+AD组在T0时具有精神病性特征的抑郁症、人格障碍和物质使用障碍（SUD）共病的比例更高，ADs药物治疗失败的次数更多，所有量表上的抑郁症状更严重（P<0.001）。与T0相比，两种治疗在T3时均使MADRS和HAM-D17上的抑郁症状显著减轻（P<0.001）；然而，SGA+AD强化治疗使平均得分下降幅度更大。逻辑回归分析表明，精神病性特征、人格障碍和SUD与SGA+AD治疗独立相关。鉴于SGA+AD强化治疗后抑郁症有更大改善，对于伴有精神病性特征、SUD和人格障碍的重度TRD，SGA强化治疗应作为一线治疗方法。
