From the Departments of Psychiatry (Carney, Freedland, Steinmeyer, Rubin) and Medicine (Rich), Washington University School of Medicine, St. Louis, Missouri.
Psychosom Med. 2018 May;80(4):385-392. doi: 10.1097/PSY.0000000000000570.
Depression is associated with an increased risk of mortality in patients with coronary heart disease (CHD). The risk may be reduced in patients who remit with adequate treatment, but few patients achieve complete remission. The purpose of this study was to identify the symptoms that persist despite aggressive treatment for depression in patients with CHD.
One hundred twenty-five patients with stable CHD who met the DSM-IV criteria for a moderate-to-severe major depressive episode completed treatment with cognitive behavior therapy, either alone or combined with an antidepressant, for up to 16 weeks. Depression symptoms were assessed at baseline and after 16 weeks of treatment.
The M (SD) Beck Depression Inventory scores were 30.0 (8.6) at baseline and 8.3 (7.5) at 16 weeks. Seventy seven (61%) of the participants who completed treatment met remission criteria (Hamilton Rating Scale for Depression ≤7) at 16 weeks. Loss of energy and fatigue were the most common posttreatment symptoms both in remitters (n = 44, 57%; n = 34, 44.2%) and nonremitters (n = 42, 87.5%; n = 35, 72.9%). These symptoms were not predicted by baseline depression severity, anxiety, demographic, or medical variables including inflammatory markers or cardiac functioning or by medical events during depression treatment.
Fatigue and loss of energy often persist in patients with CHD even after otherwise successful treatment for major depression. These residual symptoms may increase the risks of relapse and mortality. Development of effective interventions for these persistent symptoms is a priority for future research.
抑郁症与冠心病（CHD）患者的死亡率增加有关。在接受充分治疗后缓解的患者中，风险可能会降低，但很少有患者达到完全缓解。本研究的目的是确定在冠心病患者中，尽管进行了积极的抗抑郁治疗，但仍持续存在的症状。
125 名符合 DSM-IV 中度至重度重性抑郁发作标准的稳定型 CHD 患者完成了认知行为疗法的治疗，单独或联合使用抗抑郁药，最长可达 16 周。在基线和 16 周的治疗后评估抑郁症状。
贝克抑郁量表的 M（SD）得分为 30.0（8.6）在基线和 16 周时为 8.3（7.5）。完成治疗的 77 名参与者（61%）在 16 周时符合缓解标准（汉密尔顿抑郁评定量表≤7）。在缓解者（n=44，57%；n=34，44.2%）和非缓解者（n=42，87.5%；n=35，72.9%）中，治疗后最常见的症状是乏力和疲劳。这些症状不能通过基线抑郁严重程度、焦虑、人口统计学或医学变量（包括炎症标志物或心脏功能）或抑郁治疗期间的医疗事件来预测。
即使在对重度抑郁症进行了成功的治疗后，冠心病患者仍经常出现疲劳和乏力等残留症状。这些持续存在的症状可能会增加复发和死亡的风险。为这些持续存在的症状开发有效的干预措施是未来研究的重点。
