Department of Psychiatry, McGill University, Montreal, Canada.
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
Int J Neuropsychopharmacol. 2022 Jun 21;25(6):479-488. doi: 10.1093/ijnp/pyac017.
Women are nearly twice as likely as men to suffer from major depressive disorder. Yet, there is a dearth of studies comparing the clinical outcomes of women and men with treatment-resistant depression (TRD) treated with similar augmentation strategies. We aimed to evaluate the effects of the augmentation strategies in women and men at the McGill University Health Center.
We reviewed health records of 76 patients (42 women, 34 men) with TRD, treated with augmentation strategies including antidepressants (AD) with mood stabilizers (AD+MS), antipsychotics (AD+AP), or in combination (AD+AP+MS). Clinical outcomes were determined by comparing changes on the 17-item Hamilton Depression Rating Scale (HAMD-17), Montgomery-Åsberg Depression Rating Scale (MADRS), Quick Inventory of Depressive Symptomatology (QIDS-C16), and Clinical Global Impression rating scale (CGI-S) at the beginning and after 3 months of an unchanged treatment. Changes in individual items of the HAMD-17 were also compared between the groups.
Women and men improved from beginning to 3 months on all scales (P < .001, η p2 ≥ 0.68). There was also a significant sex × time interaction for all scales (P < .05, η p2 ≥ 0.06), reflecting a greater improvement in women compared with men. Specifically, women exhibited greater improvement in early (P = .03, η p2 = 0.08) and middle-of-the-night insomnia (P = .01, η p2 = 0.09) as well as psychomotor retardation (P < .001 η p2 = 0.16) and psychic (P = .02, η p2 = 0.07) and somatic anxiety (P = .01, η p2 = 0.10).
The combination of AD+AP/MS generates a significantly greater clinical response in women compared with men with TRD, supporting the existence of distinct pharmacological profiles between sexes in our sample. Moreover, they emphasize the benefit of augmentation strategies in women, underscoring the benefit of addressing symptoms such as insomnia and anxiety with AP and MS.
女性患重度抑郁症的可能性几乎是男性的两倍。然而，比较接受类似增强策略治疗的女性和男性的治疗抵抗性抑郁症（TRD）患者的临床结局的研究却很少。我们旨在评估麦吉尔大学健康中心采用增强策略治疗 TRD 的女性和男性的效果。
我们回顾了 76 名 TRD 患者（42 名女性，34 名男性）的健康记录，这些患者接受了包括抗抑郁药（AD）加心境稳定剂（AD+MS）、抗精神病药（AD+AP）或联合治疗（AD+AP+MS）在内的增强策略治疗。通过比较 17 项汉密尔顿抑郁量表（HAMD-17）、蒙哥马利-阿斯伯格抑郁量表（MADRS）、抑郁症状快速清单（QIDS-C16）和临床总体印象量表（CGI-S）在未改变治疗开始时和 3 个月后的变化来确定临床结果。还比较了 HAMD-17 各个项目在组间的变化。
女性和男性在所有量表上均从开始到 3 个月时有所改善（P<.001，ηp2≥0.68）。所有量表也存在显著的性别×时间交互作用（P<.05，ηp2≥0.06），这反映了女性的改善程度明显大于男性。具体而言，与男性相比，女性在早（P=.03，ηp2=0.08）和午夜失眠（P=.01，ηp2=0.09）以及精神运动迟滞（P<.001，ηp2=0.16）、精神（P=.02，ηp2=0.07）和躯体焦虑（P=.01，ηp2=0.10）方面的改善更为显著。
与 TRD 男性相比，AD+AP/MS 的联合使用可使女性患者产生显著更大的临床反应，这支持了我们样本中男女之间存在明显不同的药理学特征。此外，这些结果强调了增强策略在女性中的益处，突出了使用 AP 和 MS 治疗失眠和焦虑等症状的益处。
