Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom; Oxford Health NHS Trust, Warneford Hospital, Oxford, United Kingdom; P1vital Ltd, Manor House, Howbery Park, Wallingford, Oxfordshire, United Kingdom.
P1vital Ltd, Manor House, Howbery Park, Wallingford, Oxfordshire, United Kingdom.
Eur Neuropsychopharmacol. 2019 Jan;29(1):66-75. doi: 10.1016/j.euroneuro.2018.11.1102. Epub 2018 Nov 22.
Antidepressants must be taken for weeks before response can be assessed with many patients not responding to the first medication prescribed. This often results in long delays before effective treatment is started. Antidepressants induce changes in the processing of emotional stimuli early in the course of treatment. In the current study we assessed whether changes in emotional processing and subjective symptoms over the first week of antidepressant treatment predicted clinical response after 4-8 weeks of treatment. Such a predictive test may shorten the time taken to initiate effective treatment in depressed patients. Seventy-four depressed primary care patients completed measures of emotional bias and subjective symptoms before starting antidepressant treatment and then again 1 week later. Response to treatment was assessed after 4-6 weeks. The performance of classifiers based on these measures was assessed using a leave-one-out validation procedure with the best classifier then tested in an independent sample from a second study of 239 patients. The combination of a facial emotion recognition task and subjective symptoms predicted response with 77% accuracy in the training sample and 60% accuracy in the independent study, significantly better than possible using baseline response rates. The face based measure of emotional bias provided good quality data with high acceptability ratings. Changes in emotional processing can provide a sensitive early measure of antidepressant efficacy for individual patients. Early treatment induced changes in emotional processing may be used to guide antidepressant therapy and reduce the time taken for depressed patients to return to good mental health.
抗抑郁药必须服用数周后才能评估疗效，许多患者对首次开的药没有反应。这通常导致在开始有效治疗之前有很长的延迟。抗抑郁药在治疗早期会改变对情绪刺激的处理。在当前的研究中，我们评估了抗抑郁治疗开始后的第一周内情绪处理和主观症状的变化是否能预测治疗 4-8 周后的临床反应。这样的预测测试可能会缩短开始对抑郁患者进行有效治疗的时间。74 名初级保健抑郁患者在开始抗抑郁治疗前和治疗 1 周后完成了情绪偏差和主观症状的测量。治疗反应在 4-6 周后进行评估。使用留一法验证程序评估基于这些测量的分类器的性能，然后在来自第二项研究的 239 名患者的独立样本中测试最佳分类器。面部情绪识别任务和主观症状的组合在训练样本中预测反应的准确率为 77%，在独立研究中的准确率为 60%，明显优于基线反应率。基于面部的情绪偏差测量提供了高质量的数据，接受度评分很高。情绪处理的变化可以为个体患者提供抗抑郁疗效的敏感早期衡量标准。早期治疗引起的情绪处理变化可用于指导抗抑郁治疗，缩短抑郁患者恢复良好心理健康所需的时间。
