Morton Emma, Bhat Venkat, Giacobbe Peter, Lou Wendy, Michalak Erin E, Chakrabarty Trisha, Frey Benicio N, Milev Roumen V, Müller Daniel J, Parikh Sagar V, Rotzinger Susan, Kennedy Sidney H, Lam Raymond W
Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
Pharmacopsychiatry. 2021 Sep;54(5):225-231. doi: 10.1055/a-1385-0263. Epub 2021 Mar 2.
Many individuals with major depressive disorder (MDD) do not respond to initial antidepressant monotherapy. Adjunctive aripiprazole is recommended for treatment non-response; however, the impacts on quality of life (QoL) for individuals who receive this second-line treatment strategy have not been described.
We evaluated secondary QoL outcomes in patients with MDD (n=179). After 8 weeks of escitalopram, non-responders (<50% decrease in clinician-rated depression) were treated with adjunctive aripiprazole for 8 weeks (n=97); responders continued escitalopram (n=82). A repeated-measures ANOVA evaluated change in Quality of Life Enjoyment and Satisfaction Short Form scores. QoL was described relative to normative benchmarks.
Escitalopram responders experienced the most QoL improvements in the first treatment phase. For non-responders, QoL improved with a large effect during adjunctive aripiprazole treatment. At the endpoint, 47% of patients achieving symptomatic remission still had impaired QoL.
Individuals who were treated with adjunctive aripiprazole after non-response to escitalopram experienced improved QoL, but a substantial degree of QoL impairment persisted. Since QoL deficits may predict MDD recurrence, attention to ways to support this outcome is required.
许多重度抑郁症（MDD）患者对初始抗抑郁药单一疗法无反应。推荐使用阿立哌唑辅助治疗无反应者；然而，尚未描述接受这种二线治疗策略的个体的生活质量（QoL）影响。
我们评估了MDD患者（n = 179）的次要生活质量结果。在接受艾司西酞普兰治疗8周后，无反应者（临床医生评定的抑郁症状减少<50%）接受阿立哌唑辅助治疗8周（n = 97）；有反应者继续使用艾司西酞普兰治疗（n = 82）。重复测量方差分析评估生活质量享受与满意度简表得分的变化。生活质量是相对于标准基准进行描述的。
在第一个治疗阶段，艾司西酞普兰有反应者的生活质量改善最为明显。对于无反应者，在阿立哌唑辅助治疗期间生活质量有显著改善。在终点时，47%达到症状缓解的患者生活质量仍受损。
对艾司西酞普兰无反应后接受阿立哌唑辅助治疗的个体生活质量有所改善，但仍存在相当程度的生活质量损害。由于生活质量缺陷可能预测MDD复发，因此需要关注支持这一结果的方法。
