Seasonal depression - The dual vulnerability hypothesis revisited
Seasonal depression - The dual vulnerability hypothesis revisited
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DOI：
10.1016/s0165-0327(00)00196-8
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发表时间：
2001-03-01
影响因子：
6.6
通讯作者：
Zis, AP
中科院分区：
文献类型：
--
作者：
Lam, RW;Tam, EM;Zis, AP
在DSM-IV中，冬季季节性情感障碍（SAD）被归类为冬季复发性重度抑郁发作的季节性模式，夏季症状完全缓解。然而，其他有“冬季抑郁症”的群体已经被确定，包括夏季不完全缓解（ISR）和亚综合征性SAD（亚SAD，不符合重度抑郁症标准的冬季抑郁症状）的患者。在本研究中，我们比较了这三个季节组的临床特征和他们对光疗的反应。方法：在一家专门的SAD诊所评估的558例患者使用DSM-LII-R或DSM-IV标准进行诊断。在指标评估时使用检查表记录临床信息。一组患者（N = 192）接受为期2周的开放光疗试验，每天清晨使用10000勒克斯荧光灯箱照射30分钟。患者在治疗前后用29项修正汉密尔顿抑郁评定量表进行评估，临床反应被定义为分数改善大于50%。结果：部分抑郁症状、焦虑、惊恐、自杀意念及情绪障碍家族史发生率在亚抑郁组最低。光治疗的临床反应率以亚SAD组最高（N = 32, 78%）， SAD组居中（N = 113, 66%）， ISR组最低（N = 47, 51%）。局限性：这是一项在专科诊所就诊的患者的回顾性研究，尽管信息是以标准化格式获得的。光疗试验采用开放式设计，因此无法确定安慰剂的反应。结论：三组冬季抑郁症患者的临床症状及对光治疗的反应均有差异。这些结果与双重脆弱性假设一致，该假设认为这些群体是季节性和抑郁等单独因素相互作用的结果。(C) 2001 Elsevier Science B.V.版权所有
In DSM-IV, winter seasonal affective disorder (SAD) is classified as a seasonal pattern of recurrent major depressive episodes in winter with full remission of symptoms in summer. However, other groups with "winter depression" have been identified, including patients with incomplete summer remission (ISR) and subsyndromal SAD (sub-SAD, winter depressive symptoms that do not meet criteria for major depression). In this study, we compare the clinical characteristics of these three seasonal groups and their response to light therapy. Method: 558 patients assessed at a specialized SAD Clinic were diagnosed using DSM-LII-R or DSM-IV criteria. Clinical information was recorded using a checklist at index assessment. A subset of patients (N = 192) were treated with an open, 2 week trial of light therapy using a 10 000 lux fluorescent light box for 30 min per day in the early morning. Patients were assessed before and after treatment with the 29 item modified Hamilton Depression Rating Scale and clinical response was defined as greater than 50% improvement in scores. Results: The rates of some melancholic symptoms, anxiety, panic, suicidal ideation, and family history of mood disorder were lowest in the sub-SAD group. The clinical response rates to light therapy were highest in the sub-SAD group (N = 32, 78%), intermediate in the SAD group (N 113, 66%), and lowest in the ISR group (N = 47, 51%). Limitations: This was a retrospective study of patients seen in a specialty clinic, although information was obtained in a standardized format. The light therapy trial had an open design so that placebo response could not be determined. Conclusions: There are differences in both the patterns of clinical symptoms and the response to light therapy in these three groups with winter depression. These results are consistent with a dual vulnerability hypothesis that considers these groups to result from interaction of separate factors for seasonality and depression. (C) 2001 Elsevier Science B.V. All rights reserved.