Pain predicts longer time to remission during treatment of recurrent depression
Pain predicts longer time to remission during treatment of recurrent depression
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DOI：
10.4088/jcp.v66n0508
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发表时间：
2005-05-01
影响因子：
5.3
通讯作者：
Frank, E
中科院分区：
文献类型：
--
作者：
Karp, JF;Scott, J;Frank, E
疼痛和抑郁是相互加剧的。我们知道这两种症状都预示着另一种症状的未来发生。然而，疼痛是否会减缓治疗抑郁症的效果还没有得到证实。我们假设，在使用丙咪嗪和人际心理治疗之前，更高的疼痛和躯体评分预示着抑郁缓解的时间会变慢。方法：我们对一项存档研究进行了二次数据分析。受试者（N = 230）年龄在21 - 65岁之间，参加了一项复发性单相抑郁症维持治疗的研究。患者必须满足研究诊断标准（RDC）的重性抑郁发作和至少3次既往发作和明显缓解的历史要求（根据RDC）。患者还被要求在汉密尔顿抑郁量表上得分最低为15分，在拉斯金抑郁严重程度量表上得分最低为7分。本报告描述了急性治疗阶段，在此期间，所有受试者接受盐酸丙咪嗪（150至300毫克）和人际心理治疗的联合治疗。用霍普金斯症状检查表测量疼痛和躯体化。结果：高水平的疼痛和躯体化预示着更长的缓解时间。在控制了抑郁的基线严重程度后，只有疼痛仍然是预测更长的缓解时间的重要因素。头痛和肌肉酸痛是疼痛指数中的两个变量，它们的存在独立地预测了较慢的缓解。急性治疗期间疼痛和躯体化均有改善。在控制抑郁的严重程度后，疼痛和躯体化程度较高的受试者报告有更多的自杀倾向。女性比男性更痛苦。结论：疼痛，而不是躯体化，预示着更长的缓解时间，可能是更难治疗的抑郁症的标志。成人复发性抑郁症患者在治疗前应筛查是否存在疼痛，因为这些症状的出现可能需要更积极的治疗，也可能是自杀或使用双机制抗抑郁药的标志。
Introduction: Pain and depression are mutually exacerbating. We know that both of these syndromes predict the future occurrence of the other. It has not been shown, however, whether the presence of pain slows the effect of treatment for depression. We hypothesized that greater pain and somatic scores prior to treatment with imipramine and interpersonal psychotherapy would predict a slowed time to remission from depression.Method: We performed secondary data analyses of an archived study. Subjects (N = 230) were between 21 and 65 years of age and were enrolled in a study of maintenance treatment for recurrent unipolar depression. Patients had to meet Research Diagnostic Criteria (RDC) for a major depressive episode and historical requirements for at least 3 prior episodes and clear remissions (according to RDC). Patients were also required to have a minimum Hamilton Rating Scale for Depression score of 15 and a minimum score of 7 on the Raskin Severity of Depression Scale. This report describes the acute treatment phase, during which all subjects received combination therapy consisting of imipramine hydrochloride (150 to 300 mg) and interpersonal psychotherapy. Pain and somatization were measured with the Hopkins Symptom Checklist.Results: Higher levels of both pain and somatization predicted a longer time to remission. After controlling for baseline severity of depression, only pain was still significant in predicting a longer time to remission. Headache and muscle soreness were the 2 variables from the pain index whose presence independently predicted a slower remission. Both pain and somatization improved during acute treatment. Subjects with more pain and somatization, after controlling for severity of depression, reported more suicidality. Women reported more pain than men.Conclusions: Pain, but not somatization, predicted a longer time to remission and may be a marker of a more difficult-to-treat depression. Adults with recurrent depression should be screened for the presence of pain prior to treatment, as the presence of these symptoms may require more aggressive treatment or may be a marker for suicidality or the use of dual-mechanism antidepressants.