Adjuvant pioglitazone for unremitted depression: Clinical correlates of treatment response.
Adjuvant pioglitazone for unremitted depression: Clinical correlates of treatment response.
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DOI：
10.1016/j.psychres.2015.10.013
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发表时间：
2015-12-30
影响因子：
11.3
通讯作者：
Rasgon NL
中科院分区：
文献类型：
--
作者：
Lin KW;Wroolie TE;Robakis T;Rasgon NL
以前的研究表明，胰岛素增敏剂可以在治疗抑郁症中发挥重要作用，特别是在有记录的胰岛素抵抗或对标准精神药理学方法有抵抗的患者中。本研究旨在评估PPARγ激动剂吡格列酮辅助治疗对抑郁症状的影响。在一项为期12周的吡格列酮或安慰剂双盲、随机对照试验中，将接受标准精神病学治疗方案治疗抑郁症的非精神病性、非缓解性抑郁症患者（N=37）随机分配至胰岛素敏感性谱。抑郁症的改善与葡萄糖代谢的改善相关，但仅限于胰岛素抵抗患者。还显示了年龄效应，即吡格列酮的应答在年轻患者中更有益。研究结果表明，根据基线时的葡萄糖代谢状态和抑郁水平，抑郁严重程度有不同的改善。更好地理解抑郁症和IR之间的相互联系可能会导致抑郁症的概念化和治疗方式的巨大转变，更注重治疗和/或预防代谢功能障碍。
Previous studies suggest that insulin-sensitizing agents could play a significant role in the treatment of major depression, particularly depression in patients with documented insulin resistance or those who are resistant to standard psychopharmacological approaches. This study aimed to assess the effects on depressive symptoms with adjuvant treatment with the PPARγ-agonist pioglitazone. Patients (N=37) with non-psychotic, non-remitting depression receiving standard psychiatric regimens for depression were randomized across an insulin sensitivity spectrum in a 12-week double blind, randomized controlled trial of pioglitazone or placebo. Improvement in depression was associated with improvement in glucose metabolism but only in patients with insulin resistance. An age effect was also shown in that response to pioglitazone was more beneficial in younger aged patients. Study findings suggest differential improvement in depression severity according to both glucose metabolic status and level of depression at baseline. A greater understanding of the reciprocal links between depression and IR may lead to a dramatic shift in the way in which depression is conceptualized and treated, with a greater focus on treating and/or preventing metabolic dysfunction.