Small G W, Birkett M, Meyers B S, Koran L M, Bystritsky A, Nemeroff C B
Center on Aging, University of California, Los Angeles 90024-1759, USA.
J Am Geriatr Soc. 1996 Oct;44(10):1220-5. doi: 10.1111/j.1532-5415.1996.tb01373.x.
Because physical illness may influence quality of life, we assessed its impact on functional status and treatment outcome in older depressed patients who participated in a clinical trial, which showed a significantly higher remission rate for fluoxetine over placebo (31.6% vs 18.6%, P < .001).
Six-week, randomized, double-blind, placebo-controlled trial of fluoxetine, 20 mg daily.
Multiple clinical sites, both university and private.
Outpatients (N = 671) were > or = 60 years (mean +/- SD = 67.7 +/- 5.7), met DSM-III-R criteria for unipolar major depression and had baseline scores > or = 16 on the Hamilton Depression Rating Scale.
The 36-item short-form health survey (SF-36) was used to measure baseline and posttreatment functional health and well-being. Physical illness was rated by number of current chronic or historical illnesses. Change from baseline to endpoint in the Hamilton Depression Rating Scale total score was used to measure depression outcome.
Most patients reported physical illness: 83% had one or more chronic illness, and 89% had one or more historical illness. Greater numbers of baseline chronic illness indicated worse physical functioning, general health perceptions, and vitality and greater bodily pain and role limitation from physical problems. Historical physical illness was associated with worse physical functioning, vitality, general health perceptions, social functioning, and mental health. Although the number of chronic illnesses did not influence treatment response, historical physical illness was associated with greater fluoxetine response and lower placebo response.
These findings suggest that both current and previous physical illness are associated with lower quality of life in geriatric depression and that depressed older patients with chronic physical illness respond to antidepressants as well as those without such illness. Recovery from previous physical illness should be explored as a potential predictor of antidepressant treatment outcome.
由于躯体疾病可能影响生活质量，我们评估了其对参与一项临床试验的老年抑郁症患者功能状态和治疗结果的影响，该试验显示氟西汀的缓解率显著高于安慰剂（31.6%对18.6%，P<.001）。
为期六周的氟西汀随机、双盲、安慰剂对照试验，每日20毫克。
多个临床场所，包括大学和私立机构。
门诊患者（N=671）年龄≥60岁（平均±标准差=67.7±5.7），符合DSM-III-R单相重度抑郁症标准，且汉密尔顿抑郁量表基线评分≥16分。
采用36项简短健康调查问卷（SF-36）测量基线和治疗后的功能健康及幸福感。通过当前慢性或既往疾病的数量对躯体疾病进行评分。汉密尔顿抑郁量表总分从基线到终点的变化用于衡量抑郁结果。
大多数患者报告有躯体疾病：83%有一项或多项慢性疾病，89%有一项或多项既往疾病。基线慢性疾病数量越多，表明身体功能、总体健康感知、活力越差，身体疼痛和身体问题导致的角色限制越大。既往躯体疾病与较差的身体功能、活力、总体健康感知、社会社会功能和心理健康相关。虽然慢性疾病的数量不影响治疗反应，但既往躯体疾病与氟西汀反应增强和安慰剂反应降低相关。
这些发现表明，当前和既往的躯体疾病均与老年抑郁症患者较低的生活质量相关，且患有慢性躯体疾病的老年抑郁症患者对抗抑郁药的反应与无此类疾病的患者相同。应探索既往躯体疾病的康复情况作为抗抑郁治疗结果的潜在预测指标。
