Reynolds C F, Dew M A, Frank E, Begley A E, Miller M D, Cornes C, Mazumdar S, Perel J M, Kupfer D J
Department of Psychiatry, Graduate School of Public Health, University of Pittsburg Medical Center, PA, USA.
Am J Psychiatry. 1998 Jun;155(6):795-9. doi: 10.1176/ajp.155.6.795.
The goal of this study was to examine treatment outcome differences in relation to age at onset of first lifetime episode of recurrent major depression in elderly patients.
Patients were grouped as having early-onset (N = 129) or late-onset (N = 58) depression. Early onset was defined as having a first lifetime episode of major depression at age 59 or earlier; late onset was defined as age 60 or later. The two groups of patients were compared with respect to demographic and clinical characteristics, types of treatment given (nortriptyline and interpersonal psychotherapy), and treatment outcomes.
The groups did not differ in the percentage of patients who remitted, recovered, or relapsed during continuation treatment or in the percentage who experienced a recurrence of major depression during the first year of maintenance treatment. However, early-onset patients took 5-6 weeks longer to achieve remission than did late-onset patients, and a higher proportion had a history of suicide attempts.
These data suggest that age at lifetime onset of recurrent major depression does not influence short- or long-term treatment response in elderly patients treated with combined interpersonal psychotherapy and nortriptyline, with the exception of slowing the speed of remission in early-onset cases. Difference in remission speed may reflect the greater number of previous episodes in the early-onset patients. Nevertheless, the likelihood of a longer time to remission, together with a higher rate of past suicide attempts, suggests that elderly depressed patients with a history of early-onset illness need particularly careful management.
本研究的目的是探讨老年复发性重度抑郁症患者首次终生发作的发病年龄与治疗结果差异之间的关系。
患者被分为早发型（N = 129）或晚发型（N = 58）抑郁症组。早发型定义为在59岁或更早时首次出现重度抑郁症终生发作；晚发型定义为60岁或更晚。比较两组患者的人口统计学和临床特征、所给予的治疗类型（去甲替林和人际心理治疗）以及治疗结果。
在继续治疗期间缓解、康复或复发的患者百分比，以及在维持治疗的第一年中出现重度抑郁症复发的患者百分比，两组之间没有差异。然而，早发型患者达到缓解的时间比晚发型患者长5 - 6周，且有自杀未遂史的比例更高。
这些数据表明，复发性重度抑郁症的终生发病年龄不会影响接受人际心理治疗和去甲替林联合治疗的老年患者的短期或长期治疗反应，但早发型病例的缓解速度会减慢。缓解速度的差异可能反映了早发型患者既往发作次数更多。尽管如此，缓解时间较长以及既往自杀未遂率较高的可能性表明，有早发型疾病史的老年抑郁症患者需要特别谨慎的管理。
