Thom Robyn P, Palumbo Michelle L, Thompson Claire, McDougle Christopher J, Ravichandran Caitlin T
Lurie Center for Autism, 1 Maguire Road, Lexington, MA 02421, USA.
Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
Brain Sci. 2021 Sep 15;11(9):1216. doi: 10.3390/brainsci11091216.
Depression is a common psychiatric comorbidity in individuals with Down syndrome (DS), particularly adults, with an estimated lifetime prevalence of at least 10%. The current literature on the treatment of depression in adults with DS is limited to case series published more than two decades ago, prior to the widespread use of modern antidepressant medications such as selective serotonin reuptake inhibitors (SSRIs). The purpose of this retrospective chart review study was to examine the effectiveness, tolerability, and safety of SSRIs for depression in adults with DS.
Medical records of 11 adults with DS and depression were reviewed. Assignment of scores for severity (S) of symptoms of depression and improvement (I) of symptoms with treatment with an SSRI was made retrospectively using the Clinical Global Impression Scale (CGI). Demographic and clinical characteristics of the study population, SSRI name, dose, and duration of treatment; and adverse effects were also recorded.
All 11 patients (7 male, 4 female; mean age = 27.2 years, range 18-46 years) completed a 12-week treatment course with an SSRI. The median duration of time after initiation of the SSRI covered by record review was 2.1 years, with a range of 24 weeks to 6.7 years. Nine of the 11 patients (82%; 95% CI 52%, 95%) were judged responders to SSRIs based on a rating of "much improved" or "very much improved" on the CGI-I after 12 weeks of treatment (median time of follow-up was 14.4 weeks, with a range of 12.0-33.0 weeks). Adverse effects occurred in four patients (36%). The most common adverse effects were daytime sedation and anger.
In this preliminary retrospective study, the majority of patients responded to a 12-week course of SSRI treatment and some tolerated long-term use. Controlled studies are needed to further assess the efficacy, tolerability, and safety of SSRIs for the treatment of depression in adults with DS.
抑郁症是唐氏综合征（DS）患者，尤其是成年患者中常见的精神科合并症，估计终生患病率至少为10%。目前关于成年DS患者抑郁症治疗的文献仅限于二十多年前发表的病例系列，当时选择性5-羟色胺再摄取抑制剂（SSRI）等现代抗抑郁药物尚未广泛使用。这项回顾性病历审查研究的目的是检验SSRI治疗成年DS患者抑郁症的有效性、耐受性和安全性。
回顾了11例患有DS和抑郁症的成年患者的病历。使用临床总体印象量表（CGI）对抑郁症症状严重程度（S）和使用SSRI治疗后症状改善情况（I）进行回顾性评分。还记录了研究人群的人口统计学和临床特征、SSRI名称、剂量和治疗持续时间以及不良反应。
所有11例患者（7例男性，4例女性；平均年龄 = 27.2岁，范围18 - 46岁）均完成了为期12周的SSRI治疗疗程。病历审查涵盖的SSRI起始治疗后中位时间为2.1年，范围为24周至6.7年。11例患者中有9例（82%；95%可信区间52%，95%）在治疗12周后根据CGI - I评分为“明显改善”或“非常明显改善”被判定为对SSRI有反应（中位随访时间为14.4周，范围为12.0 - 33.0周）。4例患者（36%）出现不良反应。最常见的不良反应是日间镇静和愤怒。
在这项初步回顾性研究中，大多数患者对为期12周的SSRI治疗有反应，部分患者耐受长期使用。需要进行对照研究以进一步评估SSRI治疗成年DS患者抑郁症的疗效、耐受性和安全性。
