Serum folate, vitamin B12, and homocysteine in major depressive disorder, Part 1: predictors of clinical response in fluoxetine-resistant depression.
Serum folate, vitamin B12, and homocysteine in major depressive disorder, Part 1: predictors of clinical response in fluoxetine-resistant depression.
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DOI：
10.4088/jcp.v65n0810
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发表时间：
2004-08
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影响因子：
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通讯作者：
G. Papakostas;T. Petersen;D. Mischoulon;J. Ryan;A. Nierenberg;T. Bottiglieri;J. Rosenbaum;J. Alpert-J.-Al
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文献类型：
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作者：
G. Papakostas;T. Petersen;D. Mischoulon;J. Ryan;A. Nierenberg;T. Bottiglieri;J. Rosenbaum;J. Alpert-J.-Al
目的探讨氟西汀20 mg/d开放治疗无效的重度抑郁障碍(MDD)患者的血清叶酸、维生素B12和同型半胱氨酸水平与临床疗效的关系。方法55例门诊MDD患者(平均+/-SD年龄=41.7+/-10.6岁；50.9%的女性)参加DSM-III-R结构化临床访谈，并在基线(氟西汀治疗前)完成血清叶酸、维生素B12和同型半胱氨酸的测定。叶酸水平分为低水平(OR=13.2micromol/L)或正常水平。通过Logistic回归，我们评估了(1)叶酸水平低或正常，(2)B12水平正常或低，以及(3)同型半胱氨酸水平升高或正常与双盲治疗的临床反应之间的关系。这项研究于1992年11月至1999年1月进行。结果低血清叶酸水平(CHI2=3.626，p=0.04)，但与同型半胱氨酸升高(p>；0.05)或低维生素B12水平(p>；0.05)无关，与治疗反应较差有关。低叶酸患者(N=14)和无低叶酸患者(N=38)的有效率分别为7.1%和44.7%。结论低血清叶酸水平与氟西汀耐药MDD患者的进一步治疗耐药有关。
OBJECTIVE In the present study, we assessed the relationship between serum folate, vitamin B12, and homocysteine levels and clinical response in patients with major depressive disorder (MDD) who had previously failed to respond to open treatment with fluoxetine 20 mg/day and were enrolled in a 4-week, double-blind trial of either (1) fluoxetine dose increase, (2) lithium augmentation of fluoxetine, or (3) desipramine augmentation of fluoxetine. METHOD Fifty-five outpatients (mean +/- SD age = 41.7 +/- 10.6 years; 50.9% women) with MDD as assessed with the Structured Clinical Interview for DSM-III-R who were enrolled in the double-blind trial had serum folate, vitamin B12, and homocysteine measurements completed at baseline (prior to fluoxetine treatment initiation). Folate levels were classified as either low ( or = 13.2 micromol/L) or normal. With the use of a logistic regression, we then assessed the relationship between (1) low or normal folate levels, (2) normal or low B12 levels, and (3) elevated or normal homocysteine levels and clinical response to double-blind treatment. The study was conducted from November 1992 to January 1999. RESULTS Low serum folate levels (chi2=3.626, p =.04), but not elevated homocysteine (p >.05) or low vitamin B12 levels (p >.05), were associated with poorer response to treatment. The response rates for patients with (N = 14) and without (N = 38) low folate levels were 7.1% versus 44.7%, respectively. CONCLUSION Low serum folate levels were found to be associated with further treatment resistance among patients with fluoxetine-resistant MDD.