Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: A STAR*D report
Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: A STAR*D report
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DOI：
10.1176/appi.ajp.163.11.1905
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发表时间：
2006-11-01
影响因子：
17.7
通讯作者：
Fava, Maurizio
中科院分区：
文献类型：
--
作者：
Rush, A. John;Trivedi, Madhukar H.;Fava, Maurizio
目的：这份报告描述了参与者，并比较了缓解抑郁的序列替代疗法(STAR*D)试验中四个连续步骤中每一个步骤的急性和长期治疗结果。方法：一个具有广泛代表性的非精神病性重度抑郁障碍成人门诊样本接受了一个(N=3,671)到四个(N=123)连续的急性治疗步骤。那些没有通过治疗步骤获得缓解或无法耐受治疗步骤的人被鼓励进入下一步。那些从任何特定步骤中获得可接受益处(最好是症状缓解)的人可以进入为期12个月的自然主义随访阶段。在抑郁症状自评量表(QDS-SR16)上得分=5(相当于17项汉密尔顿抑郁量表[HRSD17]上的=7)定义缓解；QDS-SR16总分=11(HRSD17&>=14)定义复发。结果：QDS-SR16在第一、第二、第三和第四个急性治疗步骤的缓解率分别为36.8%、30.6%、13.7%和13.0%。总的累积缓解率为67%。总体而言，那些需要更多治疗步骤的人在自然主义的后续阶段有更高的复发率。此外，在随访时处于缓解状态的参与者的复发率低于在前三个治疗步骤后未处于缓解期的参与者。结论：当需要更多的治疗步骤时，预期在后续阶段将有较低的急性缓解率(尤其是第三和第四个治疗步骤)和较高的复发率。需要研究为个别患者确定最佳的多步骤治疗序列，并开发更广泛有效的治疗方法。
Objective: This report describes the participants and compares the acute and longer-term treatment outcomes associated with each of four successive steps in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial.Method: A broadly representative adult outpatient sample with nonpsychotic major depressive disorder received one (N = 3,671) to four (N = 123) successive acute treatment steps. Those not achieving remission with or unable to tolerate a treatment step were encouraged to move to the next step. Those with an acceptable benefit, preferably symptom remission, from any particular step could enter a 12-month naturalistic follow-up phase. A score of = 5 on the Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR16) (equivalent to = 7 on the 17-item Hamilton Rating Scale for Depression [HRSD17]) defined remission; a QIDS-SR16 total score of = 11 (HRSD17 >= 14) defined relapse.Results: The QIDS-SR16 remission rates were 36.8%, 30.6%, 13.7%, and 13.0% for the first, second, third, and fourth acute treatment steps, respectively. The overall cumulative remission rate was 67%. Overall, those who required more treatment steps had higher relapse rates during the naturalistic follow-up phase. In addition, lower relapse rates were found among participants who were in remission at follow-up entry than for those who were not after the first three treatment steps.Conclusions: When more treatment steps are required, lower acute remission rates (especially in the third and fourth treatment steps) and higher relapse rates during the follow-up phase are to be expected. Studies to identify the best multistep treatment sequences for individual patients and the development of more broadly effective treatments are needed.