Difference in treatment outcome in outpatients with anxious versus nonanxious depression: A STAR*D report
Difference in treatment outcome in outpatients with anxious versus nonanxious depression: A STAR*D report
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DOI：
10.1176/appi.ajp.2007.06111868
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发表时间：
2008-03-01
影响因子：
17.7
通讯作者：
Trivedi, Madhukar H.
中科院分区：
文献类型：
--
作者：
Fava, Maurizio;Rush, A. John;Trivedi, Madhukar H.
目的：大约一半的门诊抑郁症患者也有临床意义的焦虑水平。作者进行了二次数据分析，以比较抗抑郁药治疗结果的焦虑和非焦虑性抑郁症患者在1级和2级的星星 *D study.Method：共2,876名成人门诊抑郁症患者，从18个初级和23个精神病护理网站，接受西酞普兰在1级的星星 *D。在第2级中，共有1,292例未缓解或耐受西酞普兰的患者被随机分配转换为缓释安非他酮（N=239），舍曲林（N=238）或缓释文拉法辛（N=250）或继续服用西酞普兰并接受缓释安非他酮（N=279）或丁螺环酮（N=286）的增强治疗。每个级别的治疗可持续长达14周。如果患者在基线时17项汉密尔顿抑郁评定量表（HAM-D）的焦虑/躯体化因子评分为7分或更高，则将其指定为患有焦虑抑郁症。结果：在星星 *D的1级中，53.2%的患者有焦虑性抑郁;与非焦虑性抑郁症患者相比，这些患者的缓解可能性显著降低，且缓解时间更长。焦虑抑郁组的副作用频率、强度和负担，以及严重不良事件的数量显著更高。同样，在2级，焦虑性抑郁症患者表现出显着更糟的开关和增强options.Conclusions：焦虑性抑郁症与不良的急性结果比非焦虑性抑郁症抗抑郁治疗。
Objective: About half of outpatients with major depressive disorder also have clinically meaningful levels of anxiety. The authors conducted a secondary data analysis to compare antidepressant treatment outcomes for patients with anxious and nonanxious major depression in Levels 1 and 2 of the STAR*D study.Method: A total of 2,876 adult outpatients with major depressive disorder, enrolled from 18 primary and 23 psychiatric care sites, received citalopram in Level 1 of STAR*D. In Level 2, a total of 1,292 patients who did not remit with or tolerate citalopram were randomly assigned either to switch to sustained-release bupropion (N=239), sertraline (N=238), or extended-release venlafaxine (N=250) or to continue taking citalopram and receive augmentation with sustained-release bupropion (N=279) or buspirone (N=286). Treatment could last up to 14 weeks in each level. Patients were designated as having anxious depression if their anxiety/ somatization factor score from the 17-item Hamilton Depression Rating Scale (HAM-D) was 7 or higher at baseline. Rates of remission and response as well as times to remission and response were compared between patients with anxious depression and those with nonanxious depression.Results: In Level 1 of STAR*D, 53.2% of patients had anxious depression. Remission was significantly less likely and took longer to occur in these patients than in those with nonanxious depression. Ratings of side effect frequency, intensity, and burden, as well as the number of serious adverse events, were significantly greater in the anxious depression group. Similarly, in Level 2, patients with anxious depression fared significantly worse in both the switching and augmentation options.Conclusions: Anxious depression is associated with poorer acute outcomes than nonanxious depression following antidepressant treatment.