症状维度的关注-活动表明需要阿立哌唑增强治疗重度抑郁症的依地普仑：CAN-BIND-1 报告。

Symptom Dimension of Interest-Activity Indicates Need for Aripiprazole Augmentation of Escitalopram in Major Depressive Disorder: A CAN-BIND-1 Report.

机构信息

Dalhousie University, 5909 Veterans Memorial Lane, Halifax, NS, B3H 2E2, NS, Canada.

Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.

出版信息

J Clin Psychiatry. 2020 Jun 16;81(4):20m13229. doi: 10.4088/JCP.20m13229.

DOI:10.4088/JCP.20m13229

PMID:32558407

Abstract

OBJECTIVE

Differential predictors of response to alternative treatment options are needed to improve the outcomes in major depressive disorder. The symptom dimension comprising loss of interest and reduced activity has been reported as a predictor of poor outcome of treatment with antidepressants. We hypothesized that augmentation with partial dopamine agonist aripiprazole will be effective for individuals with pronounced interest-activity symptoms.

METHODS

We tested the hypothesis in the 2-phase Canadian Biomarker Integration Network in Depression trial 1 (CAN-BIND-1). All participants had a primary diagnosis of major depressive disorder confirmed with the Mini-International Neuropsychiatric Interview. In phase 1, 188 individuals received escitalopram monotherapy 10-20 mg daily for 8 weeks. In phase 2, nonresponders received augmentation with aripiprazole 2-10 mg daily while responders continued escitalopram monotherapy for another 8 weeks. Outcomes were measured with the Montgomery-Åsberg Depression Rating Scale (MADRS) every 2 weeks. Effects of baseline interest-activity symptoms on outcomes were tested in repeated-measures mixed-effects models.

RESULTS

Higher baseline interest-activity score (indicative of more severe loss of interest and reduction in activity) predicted worse outcome of escitalopram monotherapy in phase 1 (b = 1.75; 95% CI, 0.45 to 3.05; P = .009), but the association disappeared with the augmentation option in phase 2 (b = -0.19; 95% CI, -1.30 to 0.92; P = .739). A significant interaction between the baseline interest-activity score and aripiprazole reflected the opposite direction of the relationship between baseline interest-activity score and degree of improvement with escitalopram monotherapy versus aripiprazole augmentation (b = -1.60; 95% CI, -2.35 to -0.84; P < .001).

CONCLUSIONS

Individuals with prominent loss of interest and reduction in activity benefit less from escitalopram monotherapy and more from aripiprazole augmentation. Future trials may test the benefits of early prodopaminergic augmentation guided by interest-activity symptoms.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT01655706.

摘要

目的

需要不同的预测因素来预测对替代治疗方案的反应，以改善重度抑郁症的治疗效果。包含兴趣丧失和活动减少的症状维度已被报道为抗抑郁药治疗结局不佳的预测因素。我们假设部分多巴胺激动剂阿立哌唑增效治疗对兴趣-活动症状明显的个体将是有效的。

方法

我们在加拿大生物标志物整合网络抑郁试验 1（CAN-BIND-1）的 2 期研究中检验了这一假设。所有参与者均通过 Mini-国际神经精神访谈（MINI）确诊为原发性重性抑郁障碍。在第 1 阶段，188 名参与者接受每日 10-20 毫克的艾司西酞普兰单药治疗 8 周。在第 2 阶段，无应答者接受每日 2-10 毫克阿立哌唑增效治疗，而应答者继续接受艾司西酞普兰单药治疗 8 周。每 2 周用蒙哥马利-Åsberg 抑郁评定量表（MADRS）测量结局。使用重复测量混合效应模型检验基线兴趣-活动症状对结局的影响。

结果

更高的基线兴趣-活动评分（表明更严重的兴趣丧失和活动减少）预示着第 1 阶段艾司西酞普兰单药治疗结局更差（b = 1.75；95%CI，0.45 至 3.05；P =.009），但在第 2 阶段增效治疗时，这种相关性消失（b = -0.19；95%CI，-1.30 至 0.92；P =.739）。基线兴趣-活动评分与阿立哌唑之间的显著交互作用反映了基线兴趣-活动评分与艾司西酞普兰单药治疗与阿立哌唑增效治疗的改善程度之间关系的相反方向（b = -1.60；95%CI，-2.35 至 -0.84；P <.001）。