Little J T, Reynolds C F, Dew M A, Frank E, Begley A E, Miller M D, Cornes C, Mazumdar S, Perel J M, Kupfer D J
Mental Health Clinical Research Center for the Study of Late-Life Mood Disorders, Department of Psychiatry, University of Pittsburgh Medical Center, PA, USA.
Am J Psychiatry. 1998 Aug;155(8):1035-8. doi: 10.1176/ajp.155.8.1035.
Effective treatments are available for major depressive disorder in later life. The purpose of this study was to elucidate the frequency of treatment resistance among the elderly.
Treatment resistance, defined as lack of recovery despite combined pharmacotherapy and psychotherapy, was prospectively examined in 180 elderly patients in an episode of recurrent, nonpsychotic major depression who were referred to a university medical center for treatment. They received open acute and continuation treatment with nortriptyline and interpersonal psychotherapy.
Among the 159 patients who completed acute treatment, 19 (11.9%) did not experience a remission of depression. In addition, nine patients who had achieved remission relapsed during continuation therapy and did not recover despite vigorous treatment. Hence, excluding dropouts, 18.4% of the patients met the criteria for treatment resistance by their lack of response to acute treatment or by relapsing during continuation therapy and not recovering subsequently despite further vigorous treatment.
The study suggests a relatively low rate of resistance to treatment among depressed geriatric patients referred to a university tertiary care setting.
针对晚年的重度抑郁症有有效的治疗方法。本研究的目的是阐明老年人中治疗抵抗的发生率。
治疗抵抗定义为尽管联合药物治疗和心理治疗仍未康复，前瞻性地研究了180例复发性、非精神病性重度抑郁症发作的老年患者，这些患者被转诊至大学医学中心接受治疗。他们接受了去甲替林和人际心理治疗的开放急性和持续治疗。
在完成急性治疗的159例患者中，19例（11.9%）未实现抑郁缓解。此外，9例已实现缓解的患者在持续治疗期间复发，尽管积极治疗仍未康复。因此，排除退出者，18.4%的患者因对急性治疗无反应或在持续治疗期间复发且随后尽管进一步积极治疗仍未康复而符合治疗抵抗标准。
该研究表明，转诊至大学三级护理机构的老年抑郁症患者中治疗抵抗率相对较低。
