Predictors and moderators of time to remission of major depression with interpersonal psychotherapy and SSRI pharmacotherapy
Predictors and moderators of time to remission of major depression with interpersonal psychotherapy and SSRI pharmacotherapy
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DOI：
10.1017/s0033291710000553
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发表时间：
2011-01-01
影响因子：
6.9
通讯作者：
Forgione, R. N.
中科院分区：
文献类型：
--
作者：
Frank, E.;Cassano, G. B.;Forgione, R. N.
背景虽然许多研究表明，平均而言，抑郁症特异性心理治疗和抗抑郁药物治疗是有效的，但我们对哪种患者更有可能对其中一种产生反应知之甚少。我们试图确定是否频谱精神病理学的措施是有用的，以决定哪些单相抑郁症患者应该接受药物治疗与抑郁症特异性心理治疗。在宾夕法尼亚州匹兹堡和意大利比萨的学术医疗中心，共有318名患有重度抑郁症的成年门诊患者被随机分配接受艾司西酞普兰药物治疗或人际心理治疗（IPT）。我们主要关注的是单药治疗12周后缓解时间的预测因子和调节因子。在惊恐-广场恐惧谱自我报告（PAS-SR）中需要医疗保证因子得分较高的参与者在IPT中的缓解速度更快，而在情绪谱自我报告（MOODS-SR）中心理激活因子得分较低的参与者在选择性5-羟色胺再摄取抑制剂（SSRI）药物治疗中的缓解速度更快。单药治疗缓解时间较长的非特异性预测因素包括几个恐慌谱和情绪谱因素以及社交恐惧谱（SHY）总分。17项和25项汉密尔顿抑郁评定量表（HAMD-17和HAMD-25）以及工作和社会适应量表（WSAS）的基线评分越高，缓解时间也越长，而已婚者缓解时间越短。这项探索性研究确定了几个非特异性的预测因子，但很少有心理治疗与药物治疗结果的调节因子。它提供了有用的指标，患者的特点，通常是难以治疗，但只有有限的指导，谁受益于IPT与SSRI药物治疗。
Background. Although many studies suggest that, on average, depression-specific psychotherapy and antidepressant pharmacotherapy are efficacious, we know relatively little about which patients are more likely to respond to one versus the other. We sought to determine whether measures of spectrum psychopathology are useful in deciding which patients with unipolar depression should receive pharmacotherapy versus depression-specific psychotherapy.Method. A total of 318 adult out-patients with major depression were randomly assigned to escitalopram pharmacotherapy or interpersonal psychotherapy (IPT) at academic medical centers at Pittsburgh, Pennsylvania and Pisa, Italy. Our main focus was on predictors and moderators of time to remission on monotherapy at 12 weeks.Results. Participants with higher scores on the need for medical reassurance factor of the Panic-Agoraphobic Spectrum Self-Report (PAS-SR) had more rapid remission with IPT and those with lower scores on the psychomotor activation factor of the Mood Spectrum Self-Report (MOODS-SR) experienced more rapid remission with selective serotonin reuptake inhibitor (SSRI) pharmacotherapy. Non-specific predictors of longer time to remission with monotherapy included several panic spectrum and mood spectrum factors and the Social Phobia Spectrum (SHY) total score. Higher baseline scores on the 17- and 25-item Hamilton Depression Rating Scales (HAMD-17 and HAMD-25) and the Work and Social Adjustment Scale (WSAS) also predicted a longer time to remission, whereas being married predicted a shorter time to remission.Conclusions. This exploratory study identified several non-specific predictors but few moderators of psychotherapy versus pharmacotherapy outcome. It offers useful indicators of the characteristics of patients that are generally difficult to treat, but only limited guidance as to who benefits from IPT versus SSRI pharmacotherapy.