Predictors of relapse in a prospective study of fluoxetine treatment of major depression
Predictors of relapse in a prospective study of fluoxetine treatment of major depression
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DOI：
10.1176/appi.ajp.163.9.1542
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发表时间：
2006-09-01
影响因子：
17.7
通讯作者：
Petkova, Eva
中科院分区：
文献类型：
--
作者：
McGrath, Patrick J.;Stewart, Jonathan W.;Petkova, Eva
目的：对先前有效的抗抑郁药失去反应是一种常见的临床问题。回顾性分析表明，抗抑郁药治疗期间的反应模式（迟发性和持续性与其他模式）可用于预测持续和维持治疗期间的复发，并可能用于确定安慰剂对治疗的反应。本研究的目的是测试的预测价值的反应模式的前瞻性，并检查数据的其他预测复发。方法：570例重性抑郁症患者用氟西汀治疗12周，并确定其反应模式。那些有反应的患者（N=292）在双盲条件下接受随机分配，继续服用氟西汀或改用安慰剂，持续52周或直至复发。生存分析被用来检查的协变量对复发的影响。结果：虽然氟西汀是显着更有效的比安慰剂在维持治疗，这慢性病组有很高的复发率。与以前的研究结果相反，急性反应模式不能预测复发。慢性，症状的严重程度，神经植物性症状模式，和女性都与复发的风险显着增加，氟西汀和安慰剂之间没有观察到差异。结论：急性治疗的反应模式似乎是不一致的复发预测。慢性抑郁症患者使用活性药物和安慰剂时复发率都很高。疾病特征可预测氟西汀和安慰剂治疗无效。没有变量检查是预测之间的差异复发率氟西汀和安慰剂。
Objective: Loss of response to a previously effective antidepressant is a common clinical problem. Retrospective analyses have shown that the pattern of response during antidepressant treatment (late onset and persistent versus other patterns) can be used to predict relapse during continuation and maintenance treatment and possibly to identify placebo responses to treatment. This study was designed to test the predictive value of response pattern prospectively and to examine the data for other predictors of relapse.Method: Five hundred seventy persons with major depressive disorder were treated with fluoxetine for 12 weeks and their pattern of response was determined. Those who responded (N=292) underwent random assignment, under double-blind conditions, to continue taking fluoxetine or to switch to placebo for 52 weeks or until relapse. Survival analysis was used to examine the effect of covariates on relapse.Results: Although fluoxetine was significantly more effective than placebo during maintenance treatment, this chronically ill group had a high rate of relapse. Contrary to previous findings, a pattern of acute response was not predictive of relapse. Chronicity, symptom severity, a neurovegetative symptom pattern, and female gender were all associated with a significantly greater risk of relapse, with no difference observed between fluoxetine and placebo.Conclusions: The pattern of response to acute treatment appears to be inconsistently predictive of relapse. There is a high rate of relapse with both active medication and placebo in patients with chronic depression. Illness characteristics predict loss of response both to fluoxetine and to placebo. No variable examined was predictive of differential relapse rates between fluoxetine and placebo.