Residual symptoms and recurrence during maintenance treatment of late-life depression ☆
Residual symptoms and recurrence during maintenance treatment of late-life depression ☆
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DOI：
10.1016/j.jad.2007.01.020
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发表时间：
2007-11-01
影响因子：
6.6
通讯作者：
Reynolds, Charles F., III
中科院分区：
文献类型：
--
作者：
Dombrovski, Alexandre Y.;Mulsant, Benoit H.;Reynolds, Charles F., III
背景：许多从重度抑郁症发作中康复的老年患者继续遭受抑郁情绪、焦虑和其他严重问题的困扰。我们的研究评估了这些残留症状对晚期抑郁症维持治疗期间复发风险的影响。方法：我们分析了一项老年单相抑郁症患者维持治疗的随机临床试验数据。>= 70，其中116例患者在开放药物治疗和人际心理治疗（IPT）期间病情缓解并保持稳定，随机分为临床管理/药物治疗组；临床管理/安慰剂;每月维持IPT/药物治疗；或每月维持IPT/安慰剂。我们评估了总体残留症状（基于汉密尔顿抑郁评定量表（HAM-D）总分）和特定残留症状群的影响——随机测量的情绪症状（抑郁情绪、内疚、自杀倾向、精力/兴趣）、睡眠障碍（早期、中期、晚期失眠）和焦虑（躁动、精神和躯体焦虑、疑病症）。用匹兹堡睡眠质量指数（PSQI）评估睡眠障碍。我们使用Cox比例风险回归模型控制抗抑郁药物与安慰剂的分配，以确定复发的预测因素。结果：残余焦虑和残余睡眠障碍（由PSQI而非HAM-D测量）独立预测早期复发。局限性：使用HAM-D集群来定义残留症状；分析仅限于完成急性和继续治疗的患者。结论：在经药物治疗和心理治疗缓解的晚期抑郁症患者中，残留症状的有害影响是由于持续的焦虑，可能还有残留的睡眠障碍。(C) 2007 Elsevier B.V.版权所有
Background: Many older patients who recover from an episode of major depression continue to suffer from depressed mood, anxiety, and steep problems. Our study assesses the impact of these residual symptoms on the risk of recurrence during maintenance treatment of late-life depression.Method: We analyzed data from a randomized clinical trial of maintenance treatment in patients with unipolar depression aged. >= 70, 116 of whom remitted and remained stable during open pharmacotherapy and interpersonal psychotherapy (IPT) and were randomized to clinical management/pharmacotherapy; clinical management/placebo; monthly maintenance IPT/ pharmacotherapy; or monthly maintenance IPT/placebo. We assessed the impact of overall residual symptoms (based on the Hamilton Depression Rating Scale (HAM-D) total score) and of specific residual symptom clusters - mood symptoms (depressed mood, guilt, suicidality, energy/interests), sleep disturbance (early, middle, late insomnia), and anxiety (agitation, psychic and somatic anxiety, hypochondriasis) measured at randomization. Sleep disturbance was also assessed with the Pittsburgh Sleep Quality Index (PSQI). We used Cox proportional hazards regression models controlling for assignment to antidepressant medication versus placebo to identify predictors of recurrence.Results: Residual anxiety and residual sleep disturbance (as measured by the PSQI but not the HAM-D) independently predicted early recurrence.Limitations: Use of HAM-D clusters to define residual symptoms; analysis limited to completers of acute and continuation treatment.Conclusions: In patients with late-life depression who have remitted with pharmacotherapy and psychotherapy, the deleterious effect of residual symptoms is due to persisting anxiety and, possibly, residual sleep disturbance. (C) 2007 Elsevier B.V. All rights reserved.