Maintenance treatment of major depression in old age
Maintenance treatment of major depression in old age
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DOI：
10.1056/nejmoa052619
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发表时间：
2006-03-16
影响因子：
158.5
通讯作者：
Kupfer, DJ
中科院分区：
文献类型：
--
作者：
Reynolds, CF;Dew, MA;Kupfer, DJ
背景：患有重度抑郁症的老年患者，包括首次发作的患者，抑郁复发、残疾和死亡的风险很高。方法：在一项2×2随机、双盲、安慰剂对照试验中，我们测试了帕罗西汀维持治疗和每月人际心理治疗对70岁或70岁以上抑郁症患者的疗效(其中55%为首次发作)。在帕罗西汀和心理治疗有反应的患者中，116人被随机分配到四个维持治疗计划中的一个(帕罗西汀或安慰剂结合每月心理治疗或临床治疗)，为期两年或直到严重抑郁症复发。结果：在接受帕罗西汀和心理治疗的患者中，35%的患者在两年内复发，在接受帕罗西汀和临床治疗的患者中，有37%的患者在两年内复发，在接受安慰剂和心理治疗的患者中，有68%的患者在两年内复发(P=0.02)。在对心理治疗的效果进行调整后，接受安慰剂治疗的患者复发的相对风险是接受帕罗西汀治疗的患者的2.4倍(95%可信区间为1.4至4.2)。需要接受帕罗西汀治疗以防止一次复发的患者数量为4人(95%可信区间为2.3至10.9)。同时患有较少和较轻疾病(如高血压或心脏病)的患者从帕罗西汀中获益更多(帕罗西汀治疗与基线内科疾病严重程度之间的交互作用，P=0.03)。结论：70岁或以上的重度抑郁症患者如果接受帕罗西汀初始治疗和心理治疗有反应，则接受帕罗西汀维持治疗两年后复发抑郁的可能性较小。每月的维持性心理治疗并不能防止抑郁症复发。(ClinicalTrials.gov编号，NCT00178100。)
Background: Elderly patients with major depression, including those having a first episode, are at high risk for recurrence of depression, disability, and death.Methods: We tested the efficacy of maintenance paroxetine and monthly interpersonal psychotherapy in patients 70 years of age or older who had depression (55 percent of whom were having a first episode) in a 2-by-2, randomized, double-blind, placebo-controlled trial. Among patients with a response to treatment with paroxetine and psychotherapy, 116 were randomly assigned to one of four maintenance-treatment programs (either paroxetine or placebo combined with either monthly psychotherapy or clinical-management sessions) for two years or until the recurrence of major depression. Clinical-management sessions, conducted by the same nurses, social workers, and psychologists who provided psychotherapy, involved discussion of symptoms.Results: Major depression recurred within two years in 35 percent of the patients receiving paroxetine and psychotherapy, 37 percent of those receiving paroxetine and clinical-management sessions, 68 percent of those receiving placebo and psychotherapy, and 58 percent of those receiving placebo and clinical-management sessions (P=0.02). After adjustment for the effect of psychotherapy, the relative risk of recurrence among those receiving placebo was 2.4 times (95 percent confidence interval, 1.4 to 4.2) that among those receiving paroxetine. The number of patients needed to be treated with paroxetine to prevent one recurrence was 4 (95 percent confidence interval, 2.3 to 10.9). Patients with fewer and less severe coexisting medical conditions (such as hypertension or cardiac disease) received greater benefit from paroxetine (P=0.03 for the interaction between treatment with paroxetine and baseline severity of medical illness).Conclusions: Patients 70 years of age or older with major depression who had a response to initial treatment with paroxetine and psychotherapy were less likely to have recurrent depression if they received two years of maintenance therapy with paroxetine. Monthly maintenance psychotherapy did not prevent recurrent depression. (ClinicalTrials.gov number, NCT00178100.)