University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands.
University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands; GGZ Drenthe Mental Health Institute, Department Affective disorders, Assen, The Netherlands.
J Affect Disord. 2021 Jul 1;290:81-88. doi: 10.1016/j.jad.2021.04.097. Epub 2021 May 2.
Research so far provided few clues on the order in which depressive symptoms typically remit during treatment. This study examined which depressive symptoms improve first, and whether symptoms changed before, simultaneous with, or after the core symptoms of depression (i.e., sad mood, loss of pleasure, and loss of interest).
Participants were 176 patients with Major Depressive Disorder (MDD) receiving outpatient treatment (a combination of pharmacotherapy and psychological interventions) for depression. Participants filled out the Inventory of Depressive Symptomatology - Self Report (IDS-SR) for 16 to 20 consecutive weeks. For each symptom, the timing of onset of a persistent improvement was determined for each single-subject separately.
Which symptoms improved first differed markedly across patients. The core depression symptoms improved 1.5 to 2 times more often before (48% - 60%) than after (19% -28%) depressive cognitions ('view of myself' and 'view of the future'), anxiety symptoms ('feeling irritable' and 'feeling anxious / tense') and vegetative symptoms ('loss of energy', 'slowed down', and 'physical energy'). Only improvements in suicidal thoughts were more likely to occur before (46% - 48%) than after (29%) improvements in the depression core symptoms.
Not all 'core depression-non-core symptom' combinations could be tested because some symptoms did not improve in a sufficient number of patients.
Which improvements mark the start of symptom remission differed between patients. Improvements in the core depression symptoms 'sad mood', 'loss of interest', and 'loss of pleasure' were more likely to occur before than after improvements in non-core symptoms.
迄今为止的研究几乎没有提供任何线索表明抑郁症状在治疗过程中通常会按照什么顺序缓解。本研究探讨了哪些抑郁症状会首先改善，以及症状是否在抑郁的核心症状（即悲伤情绪、愉悦感丧失和兴趣丧失）之前、同时或之后发生变化。
参与者为 176 名接受门诊治疗（药物治疗和心理干预相结合）的重度抑郁症（MDD）患者。参与者在 16 至 20 周内连续填写抑郁症状清单自评量表（IDS-SR）。对于每个症状，分别为每个个体确定持续改善的起始时间。
不同患者的症状改善顺序有显著差异。核心抑郁症状改善的时间比抑郁认知（“自我看法”和“对未来的看法”）、焦虑症状（“易怒”和“焦虑/紧张”）和植物性症状（“精力丧失”、“减缓”和“体力”）早 1.5 至 2 倍。只有自杀念头的改善更有可能发生在抑郁核心症状改善之前（46%-48%），而不是之后（29%）。
并非所有“核心抑郁-非核心症状”组合都可以进行测试，因为有些症状没有在足够多的患者中得到改善。
哪些改善标志着症状缓解的开始在患者之间有所不同。核心抑郁症状“悲伤情绪”、“兴趣丧失”和“愉悦感丧失”的改善比非核心症状的改善更有可能发生在之前。
