Residual Symptoms After Treatment for Depression in Patients With Coronary Heart Disease.
Residual Symptoms After Treatment for Depression in Patients With Coronary Heart Disease.
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DOI：
10.1097/psy.0000000000000570
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发表时间：
2018-05
影响因子：
3.3
通讯作者：
Rich MW
中科院分区：
文献类型：
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作者：
Carney RM;Freedland KE;Steinmeyer BC;Rubin EH;Rich MW
抑郁症与冠心病（CHD）患者死亡风险增加相关。在适当的治疗缓解的患者中，风险可能会降低，但很少有患者达到完全缓解。本研究的目的是确定冠心病患者在积极治疗抑郁症后仍持续存在的症状。125例符合DSM-IV中重度抑郁发作标准的稳定型CHD患者完成了长达16周的认知行为疗法（CBT）治疗，无论是单独治疗还是与抗抑郁药联合治疗。在基线和治疗16周后评估抑郁症状。Beck抑郁量表（BDI-II）的平均评分在基线时为30.0 ± 8.6，在16周时为8.3 ± 7.5。77例（61%）完成治疗的受试者在16周时符合缓解标准（汉密尔顿抑郁评定量表[HAM-D-17] ≤ 7）。能量丧失和疲劳是缓解者（N=44，57%; N=34，44.2%）和非缓解者（N=42，87.5%; N=35，72.9%）中最常见的治疗后症状。这些症状不能通过基线抑郁严重程度、焦虑、人口统计学或医学变量（包括炎症标志物或心脏功能）或抑郁症治疗期间的医学事件来预测。冠心病患者即使在成功治疗抑郁症后，疲劳和能量损失也经常持续存在。这些残留症状可能会增加复发和死亡的风险。开发针对这些持续症状的有效干预措施是未来研究的优先事项。
Depression is associated with an increased risk of mortality in patients with coronary heart disease (CHD). The risk may be reduced in patients who remit with adequate treatment, but few patients achieve complete remission. The purpose of this study was to identify the symptoms that persist despite aggressive treatment for depression in patients with CHD. One hundred twenty-five patients with stable CHD who met the DSM-IV criteria for a moderate-to-severe major depressive episode completed treatment with cognitive behavior therapy (CBT), either alone or combined with an antidepressant, for up to 16 weeks. Depression symptoms were assessed at baseline and after 16 weeks of treatment. The mean Beck Depression Inventory (BDI-II) scores were 30.0 ± 8.6 at baseline and 8.3 ± 7.5 at 16 weeks. Seventy-seven (61%) of the participants who completed treatment met remission criteria (Hamilton Rating Scale for Depression [HAM-D-17] ≤ 7) at 16 weeks. Loss of energy and fatigue were the most common post-treatment symptoms both in remitters (N=44, 57%; N=34, 44.2%) and nonremitters (N=42, 87.5%; N=35, 72.9%). These symptoms were not predicted by baseline depression severity, anxiety, demographic or medical variables including inflammatory markers or cardiac functioning, or by medical events during depression treatment. Fatigue and loss of energy often persist in patients with CHD even after otherwise successful treatment for major depression. These residual symptoms may increase the risks of relapse and mortality. Development of effective interventions for these persistent symptoms is a priority for future research.