Patterns and predictors of remission, response and recovery in major depression treated with fluoxetine or nortriptyline
Patterns and predictors of remission, response and recovery in major depression treated with fluoxetine or nortriptyline
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DOI：
10.1046/j.1440-1614.2001.01026.x
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发表时间：
2002-06-01
影响因子：
4.6
通讯作者：
Stevens, IF
中科院分区：
文献类型：
--
作者：
Joyce, PR;Mulder, RT;Stevens, IF
目的：本文的第一个目的是描述随机接受氟西汀或去甲替林治疗的重性抑郁症患者的缓解、反应和恢复模式。第二个目标是报告的人口统计学和诊断预测的反应和恢复在这些抑郁症patients.Method：195例重度抑郁症患者被招募为这个门诊研究。经过详细的临床和神经生物学评价患者随机接受氟西汀或去甲替林作为初始抗抑郁治疗treatment.Results：在195例抑郁症患者随机治疗，154个完成了足够的6周的试验，无论是氟西汀或去甲替林作为他们的初始抗抑郁药。在41例未完成充分试验的患者中，随机分配至去甲替林组的患者脱落率较高（p = 0.02）。在确定脱落方面，药物和性别也存在重要的相互作用，因为女性未完成充分的去甲替林试验，男性未完成充分的氟西汀试验（p = 0.002）。在154名完成了为期6周的抗抑郁试验的患者中，6周抑郁严重程度或改善百分比的测量结果没有显着差异。然而，如果我们使用意向治疗分析并将结果分为应答、缓解或恢复，则氟西汀的恢复率显著高于去甲替林（p = 0.005）。使用意向治疗分析，氟西汀在女性、25岁以下和非典型抑郁症患者中的疗效优于去甲替林（上级）。与药物无关，慢性抑郁症患者的预后较差。结论：在随机接受去甲替林或氟西汀治疗的抑郁症患者样本中，6周内氟西汀和去甲替林之间抑郁症状的变化相当。然而，当我们考虑临床上更重要的恢复变量时，则百忧解优于去甲替林（上级）。对去甲替林反应较差的预测因素是性别、年轻和非典型抑郁症。这一结果挑战了选择性5-羟色胺再摄取抑制剂（SSRIs）和三环类抗抑郁药疗效相当的传统观念。
Objective: The first objective of this paper was to describe the pattern of remission, response and recovery in patients with major depression who were randomised for treatment with fluoxetine or nortriptyline. The second objective was to report on the demographic and diagnostic predictors of the response and recovery in these depressed patients.Method: One hundred and ninety-five patients with major depression were recruited for this outpatient study. After a detailed clinical and neurobiological evaluation patients were randomized to receive either fluoxetine or nortiptyline as an initial antidepressant treatment.Results: Of the 195 depressed patients randomised to treatment, 154 completed an adequate 6-week trial of either fluoxetine or nortriptyline as their initial antidepressant. Of the 41 patients who did not complete an adequate trial the dropout rate was higher on those randomized to nortriptyline (p = 0.02). There was also an important interaction of drug and gender in determining dropouts in that women did not complete an adequate trial with nortriptyline and men did not complete an adequate trial with fluoxetine (p = 0.002). Of the 154 patients who completed an adequate 6-week antidepressant trial there were no significant differences in 6-week measures of depression severity or of percentage improvement. However, if we use an intention to treat analysis and dichotomise outcomes into response, remission or recovery; then recovery rates were significantly higher with fluoxetine than nortriptyline (p = 0.005). Using an intention to treat analysis fluoxetine was superior to nortriptyline in women, in those less than 25-years old, and in those with atypical depression. Independent of drug, those with chronic depressions had a poorer outcome.Conclusion: In this sample of depressed patients randomized to nortriptyline or fluoxetine the change in depressive symptoms over 6 weeks were comparable between fluoxetine and nortriptyline. However, when we look at the more clinically important variable of recovery then fluoxetine was superior to nortriptyline. Predictors of a poorer response to nortriptyline were gender, young age and atypical depression. The results challenge traditional beliefs that selec-tive serotonin re-uptake inhibitors (SSRIs) and tricyclic antidepressant have comparable efficacy.