Opdyke K S, Reynolds C F, Frank E, Begley A E, Buysse D J, Dew M A, Mulsant B H, Shear M K, Mazumdar S, Kupfer D J
Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, PA 15213, USA.
Depress Anxiety. 1996;4(6):312-9. doi: 10.1002/(SICI)1520-6394(1996)4:6<312::AID-DA7>3.0.CO;2-D.
The objectives of this report were (1) to describe residual depressive symptoms in elderly patients during continuation therapy with combined nortriptyline and interpersonal psychotherapy; (2) to determine which symptoms were persistent; (3) to determine the clinical correlates of residual depressive symptoms; and (4) to document distinct response pattern clusters during combined continuation therapy.
Box plot analyses of Hamilton depression scores and Global Assessment Scale scores, repeated twice monthly over 4 months, were conducted using data from 105 elderly depressives. Temporal trends in the data were examined via random regression analysis. Individual trajectories for each of the 105 patients were examined for patterns of response during continuation therapy.
We observed a low mean Hamilton rating of 7 (SD = 2.3) at the start of continuation therapy and 5 (SD = 3.0) at the end. Both Hamilton and GAS scores showed modest but significant improvement over time. Hamilton variability was most apparent in symptoms of mood lowering, apathy, anxiety (psychological and somatic), feelings of guilt, anergia, insomnia, and loss of libido; other symptoms (retardation, agitation, hypochondriasis, loss of appetite, loss of weight, suicidal ideation, and loss of insight) showed clear resolution. A diagnosis of RDC situational depression was associated with higher levels of residual symptoms, while level of chronic medical burden, personality dysfunction, and social support were not. Examination of response patterns showed that a quarter of patients experienced one or more brief symptomatic exacerbations.
On average, an excellent level of symptom resolution was achieved for most patients with Hamilton scores comparable to those seen in healthy elderly controls. These data support a position of therapeutic optimism in late-life depression and underscore full remission as an achievable therapeutic goal.
本报告的目的是：（1）描述老年患者在接受去甲替林与人际心理治疗联合持续治疗期间的残留抑郁症状；（2）确定哪些症状持续存在；（3）确定残留抑郁症状的临床相关因素；（4）记录联合持续治疗期间不同的反应模式簇。
使用来自105名老年抑郁症患者的数据，对汉密尔顿抑郁量表评分和总体评定量表评分进行箱线图分析，在4个月内每月重复两次。通过随机回归分析检查数据的时间趋势。检查了105名患者中每一位患者在持续治疗期间的个体反应轨迹模式。
我们观察到持续治疗开始时汉密尔顿平均评分为7（标准差 = 2.3），结束时为5（标准差 = 3.0）。汉密尔顿量表和总体评定量表评分均随时间有适度但显著的改善。汉密尔顿量表评分的变异性在情绪低落、冷漠、焦虑（心理和躯体）、内疚感、乏力、失眠和性欲减退等症状中最为明显；其他症状（迟缓、激越、疑病症、食欲不振、体重减轻、自杀观念和自知力丧失）则明显缓解。精神障碍诊断与统计手册情境性抑郁诊断与较高水平的残留症状相关，而慢性医疗负担水平、人格障碍和社会支持则无关。对反应模式的检查表明，四分之一的患者经历了一次或多次短暂的症状加重。
平均而言，大多数患者的症状缓解程度极佳，汉密尔顿评分与健康老年对照组相当。这些数据支持对老年抑郁症治疗持乐观态度，并强调完全缓解是一个可实现的治疗目标。
