Lin Po-Chun, Yeh Ta-Chuan, Bai Ya-Mei, Hsu Ju-Wei, Huang Kai-Lin, Ko Nai-Ying, Chu Che-Sheng, Chu Hsuan-Te, Tsai Shih-Jen, Chen Tzeng-Ji, Liang Chih-Sung, Chen Mu-Hong
Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
J Clin Psychiatry. 2022 Mar 23;83(3):21m14073. doi: 10.4088/JCP.21m14073.
The association of treatment resistance with physical and psychiatric comorbidities remains unclear in elderly patients with late-onset major depressive disorder (MDD). Participants were selected from the Taiwan National Health Insurance Research Database. We included patients aged ≥ 65 years with first-episode MDD ( codes: 296.2X and 296.3X) between January 1, 2001, and December 31, 2010. All participants were followed for 1 year to investigate the incidence of treatment resistance. Treatment-resistant depression (TRD) was defined as unresponsiveness to at least 2 antidepressants, and treatment-resistant tendency (TRT) was defined as unresponsiveness to the first antidepressant. Physical comorbidities were assessed with the Charlson Comorbidity Index (CCI). 27,189 patients with late-onset MDD were included, among whom 16.6% had the diagnosis of anxiety disorders, 1.5% had alcohol use disorders, and 1.6% had substance use disorder. For physical comorbidities, only 16.6% of patients had a CCI score of 0. During the first year of treatment, 22.1% of patients met TRT criteria, and 1.6% developed TRD. Anxiety disorders (odds ratio: 2.06; 95% confidence interval [CI], 1.67-2.53), substance use disorders (2.11; 95% CI, 1.26-3.53), and higher CCI scores (1.06; 95% CI, 1.01-1.10) were significantly associated with TRD, while anxiety disorders (1.44; 95% CI, 1.34-1.55) and higher CCI scores (1.06; 95% CI, 1.05-1.08) were significantly associated with TRT. Approximately one-fourth of elderly patients responded poorly to the first antidepressant treatment during the first year of late-onset MDD. Psychiatric comorbidities were more associated with the risk of early TRT than were physical comorbidities.
在老年迟发性重度抑郁症（MDD）患者中，治疗抵抗与躯体和精神共病之间的关联仍不明确。研究对象选自台湾国民健康保险研究数据库。我们纳入了2001年1月1日至2010年12月31日期间年龄≥65岁的首发MDD患者（编码：296.2X和296.3X）。所有参与者随访1年以调查治疗抵抗的发生率。难治性抑郁症（TRD）定义为对至少2种抗抑郁药无反应，难治性倾向（TRT）定义为对第一种抗抑郁药无反应。采用Charlson共病指数（CCI）评估躯体共病情况。共纳入27189例迟发性MDD患者，其中16.6%诊断为焦虑症，1.5%患有酒精使用障碍，1.6%患有物质使用障碍。在躯体共病方面，仅16.6% 的患者CCI评分为0。在治疗的第一年，22.1% 的患者符合TRT标准，1.6% 发展为难治性抑郁症。焦虑症（比值比：2.06；95%置信区间[CI]，1.67 - 2.53）、物质使用障碍（2.11；95%CI，1.26 - 3.53）和较高的CCI评分（1.06；95%CI，1.01 - 1.10）与TRD显著相关，而焦虑症（1.44；95%CI，1.34 - 1.55）和较高的CCI评分（1.06；95%CI，1.05 - 1.08）与TRT显著相关。在迟发性MDD的第一年，约四分之一的老年患者对第一种抗抑郁药治疗反应不佳。精神共病比躯体共病更易与早期TRT风险相关。
