Hirschfeld R M, Russell J M, Delgado P L, Fawcett J, Friedman R A, Harrison W M, Koran L M, Miller I W, Thase M E, Howland R H, Connolly M A, Miceli R J
Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch at Galveston 77555-0429, USA.
J Clin Psychiatry. 1998 Dec;59(12):669-75. doi: 10.4088/jcp.v59n1205.
The literature on predictors of response to treatment of nonchronic major depression has identified shorter duration of illness, acute onset, and less severity of illness as positive predictors. Unfortunately, there are almost no data on predictors of response to treatment for chronic depression. This study examined predictors of response to pharmacotherapy (sertraline or imipramine) in the treatment of outpatients who had DSM-III-R-defined chronic major or double depression.
The acute phase of the Chronic Major Depression and Double Depression Study is a double-blind, randomized, parallel-group 12-week comparison of sertraline and imipramine. Analyses are based on 623 patients who comprised the intent-to-treat sample, of whom 299 were nonresponders and 324 were responders, defined by a priori criteria as either remission or satisfactory therapeutic response. A stepwise logistic multiple regression analysis was performed on candidate clinical, psychosocial, and demographic variables previously identified as statistically significant in an attempt to develop a predictive model of positive antidepressant response.
The sociodemographic variables that were predictive of positive response included living with spouse or partner or being at least a high school graduate. With regard to symptomatology and clinical history, responders had significantly lower baseline depression severity scores. In general, comorbid anxiety, substance abuse, and personality disorders did not influence rates of response. However, the presence of depressive personality traits was associated with a higher nonresponse rate. Among psychosocial variables, longer duration of personal relationships as well as higher baseline quality of life were associated with positive response. A stepwise logistic multiple regression identified 5 variables-living with spouse or partner, higher educational level, passive-aggressive personality, lower introverted-tense personality traits, and higher quality of life--that significantly and independently contributed to the predictive model. This model correctly classified 67% of patients.
A higher baseline quality of life, living with spouse or partner, and having more education were the strongest predictors of response to acute pharmacotherapy among chronically depressed patients. Clinical variables and comorbidity were not identified as independent predictors, although personality traits did appear to influence treatment response. Overall, the predictive value of these baseline measures was modest, and therefore of limited clinical utility.
关于非慢性重度抑郁症治疗反应预测因素的文献表明，病程较短、急性起病和病情较轻是积极的预测因素。不幸的是，关于慢性抑郁症治疗反应预测因素的数据几乎没有。本研究调查了接受DSM-III-R定义的慢性重度或双重抑郁症门诊患者药物治疗（舍曲林或丙咪嗪）反应的预测因素。
慢性重度抑郁症和双重抑郁症研究的急性期是一项双盲、随机、平行组的12周舍曲林和丙咪嗪对比研究。分析基于623名构成意向性治疗样本的患者，其中299名无反应者和324名反应者，根据预先设定的标准定义为缓解或满意的治疗反应。对先前确定具有统计学意义的候选临床、心理社会和人口统计学变量进行逐步逻辑多元回归分析，试图建立抗抑郁药阳性反应的预测模型。
预测阳性反应的社会人口统计学变量包括与配偶或伴侣同住或至少是高中毕业生。在症状学和临床病史方面，反应者的基线抑郁严重程度评分显著较低。一般来说，共病焦虑、药物滥用和人格障碍不影响反应率。然而，抑郁性人格特质的存在与较高的无反应率相关。在心理社会变量中，人际关系持续时间较长以及基线生活质量较高与阳性反应相关。逐步逻辑多元回归确定了5个变量——与配偶或伴侣同住、教育水平较高、被动攻击型人格、内向紧张人格特质较低以及生活质量较高——这些变量对预测模型有显著且独立的贡献。该模型正确分类了67%的患者。
较高的基线生活质量、与配偶或伴侣同住以及接受更多教育是慢性抑郁症患者急性药物治疗反应的最强预测因素。临床变量和共病未被确定为独立预测因素，尽管人格特质似乎确实影响治疗反应。总体而言，这些基线测量的预测价值不大，因此临床效用有限。
