Insomnia Moderates Outcome of Serotonin-Selective Reuptake Inhibitor Treatment in Depressed Youth
Insomnia Moderates Outcome of Serotonin-Selective Reuptake Inhibitor Treatment in Depressed Youth
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DOI：
10.1089/cap.2011.0096
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发表时间：
2012-02-01
影响因子：
1.9
通讯作者：
Croarkin, Paul
中科院分区：
文献类型：
--
作者：
Emslie, Graham J.;Kennard, Betsy D.;Croarkin, Paul
目的：在大多数患有抑郁症的年轻人中，抑郁症是明显的，并且与较差的结果相关。关于失眠对急性治疗的影响的数据有限，考虑到它们有恶化睡眠结构的趋势，这与选择性重摄取抑制剂特别相关。方法：309名儿童和青少年（7-18岁）随机接受氟西汀（n = 157）或安慰剂（n = 152）治疗8-9周（Emslie et al. 1997，2002）。基线时严重失眠定义为儿童抑郁评定量表修订版[CDRS-R]睡眠项目>= 4。结果的措施是CDRS-R，反应，和remission.Results：inflammation报告在172/309（55.7%）的青年，并与较高的抑郁症的严重程度和更大的疲劳，自杀意念，身体的投诉，并降低浓度。虽然有失眠或无失眠的患者的反应率相似（51.7%对55.7%），但年龄组之间存在显著差异。在青少年中，失眠者对氟西汀的反应较低（39.2%; 20/51）（65.9%; 27/41; p = 0.013），而在接受氟西汀治疗的儿童中，（69.4%; 25/36）高于无失眠者（41.4%; 12/29; p = 0.027）。在两个年龄组中，胰岛素均不影响对安慰剂的反应。在青少年中，CDRS-R总分的总体最小二乘均值氟西汀组中失眠患者与非失眠患者之间（8周治疗期间）存在显著差异（43.65 [SE = 1.31] vs.36.58 [SE = 1.45]，F = 12.69，df = 1，169，p = 0.0005; d = 0.82），但在安慰剂组中未发生（44.91[SE = 1.34] vs. 43.75[SE = 1.68]，F = 0.29，df = 1，179，p = 0.591; d = 0.15）。虽然报告严重失眠的青少年对抗抑郁药治疗的反应可能低于无失眠的青少年，但儿童在失眠时对氟西汀的反应更大。针对青少年睡眠障碍的额外干预可能是必要的。
Objective: Insomnia is evident in the majority of youth with depression, and is associated with poorer outcomes. There are limited data on the impact of insomnia in response to acute treatment, which is particularly relevant with serotonin-selective reuptake inhibitors, given their tendency to worsen sleep architecture.Methods: Three hundred nine children and adolescents (ages 7-18 years) were randomized to fluoxetine (n = 157) or placebo (n = 152) for 8-9 weeks (Emslie et al. 1997, 2002). Substantial insomnia at baseline was defined as a child's depression rating scale-revised [CDRS-R] sleep item >= 4. Outcome measures were CDRS-R, response, and remission.Results: Insomnia was reported in 172/309 (55.7%) youth, and was associated with higher depression severity and greater fatigue, suicidal ideation, physical complaints, and decreased concentration. While response rates were similar in those with or without insomnia overall (51.7% vs. 55.7%), there is a significant difference by age group. Among adolescents, those with insomnia were less likely to respond to fluoxetine (39.2%; 20/51) than those without (65.9%; 27/41; p = 0.013), while in children on fluoxetine, those with insomnia were more likely to respond to fluoxetine (69.4%; 25/36) than those without insomnia (41.4%; 12/29; p = 0.027). Insomnia did not impact the response to placebo in either age group. Within adolescents, the overall least squares means for CDRS-R total score (across the 8 weeks of treatment) were significantly different between those who had insomnia versus those who did not within the fluoxetine group (43.65 [SE = 1.31] vs. 36.58[SE = 1.45], F = 12.69, df = 1, 169, p = 0.0005; d = 0.82), but not within the placebo group (44.91[SE = 1.34] vs. 43.75[SE = 1.68], F = 0.29, df = 1, 179, p = 0.591; d = 0.15).Conclusions: While adolescents reporting substantial insomnia were less likely to respond to antidepressant treatment than those without insomnia, children were more responsive to fluoxetine when they had insomnia. Additional intervention targeting sleep disturbance may be warranted in adolescents.