Fugger Gernot, Bartova Lucie, Dold Markus, Fabbri Chiara, Fanelli Giuseppe, Zanardi Raffaella, Kautzky Alexander, Zohar Joseph, Souery Daniel, Mendlewicz Julien, Montgomery Stuart, Rujescu Dan, Serretti Alessandro, Kasper Siegfried
Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy.
Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy; Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
Prog Neuropsychopharmacol Biol Psychiatry. 2022 Mar 2;114:110480. doi: 10.1016/j.pnpbp.2021.110480. Epub 2021 Nov 23.
About two thirds of the patients with major depressive disorder (MDD) do not sufficiently respond to monotherapy with antidepressants (ADs) which makes them reliant on further treatment approaches. Hereby, combination of different ADs and augmentation with second-generation antipsychotics (SGAs) are widely used and recommended psychopharmacotherapeutic strategies. The present secondary analyses are based on an international, naturalistic, cross-sectional multicenter study conducted by the European Group for the Study of Resistant Depression. Comparing socio-demographic and clinical characteristics of 436 adult MDD patients receiving either SGAs (N = 191, 43.8%) or ADs (N = 245, 56.2%), that were additionally administered to their first-line AD psychopharmacotherapy, we aimed to identify possible trajectories of decision-making for clinicians regarding which treatment option to prefer in individual patients. Our most robust findings represent an association of SGA augmentation with the presence of psychotic symptoms, longer mean duration of lifetime psychiatric hospitalizations, employment of further augmentation strategies with mood-stabilizers and benzodiazepines, and a trend towards higher mean daily dosages of their first-line ADs and current suicidal risk. Treatment outcome was not significantly different between patients receiving either SGA augmentation or AD combination. Being aware of limitations inherent to the cross-sectional study design and the lack of randomization, more severe and rather chronic conditions in MDD seemed to encourage clinicians to choose SGA augmentation over AD combination. The fact that mood-stabilizers and/or benzodiazepines were more frequently co-administered with SGAs may represent a requirement of an overall refined psychopharmacotherapy including additional fast-acting agents with potent AD, tranquilizing and anti-suicidal effects in MDD patients experiencing challenging clinical manifestations. New glutamatergic substances seem to be promising in this regard.
约三分之二的重度抑郁症（MDD）患者对抗抑郁药（ADs）单一疗法反应不充分，这使得他们依赖进一步的治疗方法。因此，不同抗抑郁药联合使用以及加用第二代抗精神病药（SGAs）是广泛应用且推荐的精神药物治疗策略。本二次分析基于欧洲难治性抑郁症研究组开展的一项国际、自然主义、横断面多中心研究。比较了436例接受SGAs（N = 191，43.8%）或ADs（N = 245，56.2%）治疗的成年MDD患者的社会人口统计学和临床特征，这些患者在一线AD精神药物治疗基础上额外接受了上述治疗，我们旨在确定临床医生在个体患者中选择哪种治疗方案时可能的决策轨迹。我们最有力的研究结果表明，SGA增效与精神病性症状的存在、终生精神科住院平均时长更长、使用心境稳定剂和苯二氮䓬类药物的进一步增效策略以及一线ADs平均日剂量较高和当前自杀风险呈正相关。接受SGA增效或AD联合治疗的患者之间治疗结局无显著差异。鉴于横断面研究设计固有的局限性以及缺乏随机分组，MDD中更严重且病程较长的病情似乎促使临床医生选择SGA增效而非AD联合治疗。心境稳定剂和/或苯二氮䓬类药物更常与SGAs联合使用这一事实可能表明，对于临床表现具有挑战性的MDD患者，全面优化的精神药物治疗需要包括具有强效抗抑郁、镇静和抗自杀作用的额外速效药物。新型谷氨酸能物质在这方面似乎很有前景。
