Cao Bing, Park Caroline, Subramaniapillai Mehala, Lee Yena, Iacobucci Michelle, Mansur Rodrigo B, Zuckerman Hannah, Phan Lee, McIntyre Roger S
School of Public Health, Peking University, Beijing, China.
Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
Front Psychiatry. 2019 Jan 31;10:17. doi: 10.3389/fpsyt.2019.00017. eCollection 2019.
Anhedonia is a common, persistent, and disabling phenomenon in treated adults with Major Depressive Disorder (MDD). Hitherto, relatively few antidepressant agents have been evaluated with respect to their effect on anhedonia in MDD. This is a analysis of a primary study that sought to evaluate the sensitivity to change of the THINC-integrated tool (THINC-it) in MDD (ClinicalTrials.gov Identifier: NCT03053362). Adults meeting DSM-5 criteria for MDD with at least moderate depressive symptom severity [i.e., Montgomery Åsberg Depression Rating Scale (MADRS) total score ≥20] were eligible. Subjects were recruited between October 2017 and August 2018 in Toronto, Ontario at the Brain and Cognition Discovery Foundation. All subjects received open-label vortioxetine (10-20 mg/day, flexibly-dosed) for 8 weeks. Herein, the primary outcome of interest was the change from baseline to endpoint in the Snaith-Hamilton Pleasure Scale (SHAPS) total score, as well as the MADRS anhedonia factor. The mediational effects of improvements in anhedonia on general function and quality of life, as measured by the Sheehan Disability Scale (SDS) and the 5-Item World Health Organization Well-Being Index (WHO-5), were secondarily assessed. A total of 100 subjects with MDD were enrolled in the primary study and began treatment with vortioxetine. Vortioxetine significantly improved anhedonia as evidenced by significant baseline to endpoint improvements in SHAPS and MADRS anhedonia factor scores ( < 0.0001). Improvements in the SHAPS and the MADRS anhedonia factor correlated with improvements in general function (i.e., SDS) and quality of life (i.e., WHO-5) ( < 0.0001). Notably, improvements in anhedonia were found to mediate the association between improvements in overall depressive symptom severity (i.e., MADRS total score) and social functioning (i.e., social life component of the SDS) ( = 0.026). The unmet need in depression is to improve patient functioning and other patient-reported outcomes (e.g., quality of life). Antidepressant interventions capable of attenuating anhedonia as well as cognitive dysfunction in MDD may help in this regard, as improvement in these domains have been associated with improvement in psychosocial function and quality of life.
快感缺失是成年重度抑郁症（MDD）患者经治疗后常见、持续且致残的现象。迄今为止，相对较少的抗抑郁药针对MDD患者的快感缺失作用进行过评估。这是一项对一项初步研究的分析，该初步研究旨在评估THINC综合工具（THINC-it）对MDD患者变化的敏感性（ClinicalTrials.gov标识符：NCT03053362）。符合DSM-5标准的MDD成年患者，且抑郁症状至少为中度严重程度[即蒙哥马利-艾斯伯格抑郁量表（MADRS）总分≥20]者符合入选条件。研究对象于2017年10月至2018年8月在安大略省多伦多市的大脑与认知发现基金会招募。所有研究对象接受开放标签的伏硫西汀（10 - 20毫克/天，灵活给药）治疗8周。在此，主要关注的结局是斯奈斯 - 汉密尔顿快感量表（SHAPS）总分从基线到终点的变化，以及MADRS快感缺失因子。其次评估了通过希恩残疾量表（SDS）和世界卫生组织5项幸福指数（WHO-5）测量的快感缺失改善对总体功能和生活质量的中介效应。共有100名MDD患者纳入了初步研究并开始接受伏硫西汀治疗。伏硫西汀显著改善了快感缺失，SHAPS和MADRS快感缺失因子评分从基线到终点有显著改善证明了这一点（<0.0001）。SHAPS和MADRS快感缺失因子的改善与总体功能（即SDS）和生活质量（即WHO-5）的改善相关（<0.0001）。值得注意的是，发现快感缺失的改善介导了总体抑郁症状严重程度（即MADRS总分）的改善与社会功能（即SDS的社会生活部分）之间的关联（=0.026）。抑郁症未满足的需求是改善患者功能和其他患者报告的结局（例如生活质量）。能够减轻MDD患者快感缺失以及认知功能障碍的抗抑郁干预措施在这方面可能会有所帮助，因为这些领域的改善与心理社会功能和生活质量的改善相关。
