Treating depression to remission in older adults: a controlled evaluation of combined escitalopram with interpersonal psychotherapy versus escitalopram with depression care management.
Treating depression to remission in older adults: a controlled evaluation of combined escitalopram with interpersonal psychotherapy versus escitalopram with depression care management.
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DOI：
10.1002/gps.2443
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发表时间：
2010-11
影响因子：
4
通讯作者：
Frank, Ellen
中科院分区：
文献类型：
--
作者：
Reynolds, Charles F., III;Dew, Mary Amanda;Martire, Lynn M.;Miller, Mark D.;Cyranowski, Jill M.;Lenze, Eric;Whyte, Ellen M.;Mulsant, Benoit H.;Pollock, Bruce G.;Karp, Jordan F.;Gildengers, Ariel;Szanto, Katalin;Dombrovski, Alexandre Y.;Andreescu, Carmen;Butters, Meryl A.;Morse, Jennifer Q.;Houck, Patricia R.;Bensasi, Salem;Mazumdar, Sati;Stack, Jacqueline A.;Frank, Ellen
关键词：
超过一半的老年人对一线抗抑郁药物治疗只有部分反应。我们的目的是检验以下假设：与艾司西酞普兰联合抑郁症护理管理（DCM）相比，与艾司西酞普兰联合使用抑郁症特异性心理治疗（人际心理治疗-IPT）时，部分应答者的缓解率更高，症状消退更快。我们在艾司西酞普兰部分应答者中进行了一项为期16周的IPT和DCM随机临床试验，招募了124名60岁及以上的门诊患者。主要结局，缓解，定义为连续三周汉密尔顿抑郁量表（17项）评分≤7分。我们对缓解时间进行了考克斯回归分析，并对缓解率进行了logistic建模。我们通过混合效应模型测试了汉密尔顿抑郁评分随时间变化的组间差异。在意向治疗分析（IPT vs DCM：58 [95% CI：46，71] vs 45% [33，58]; p = 0.14）和完成者分析（IPT vs DCM：58% [95% CI：44，72] vs 43% [30，57]; p = 0.20）中，艾司西酞普兰联合IPT和DCM的缓解率相似。两种治疗的症状改善速度无差异。没有显示出IPT相对于DCM的额外优势。抑郁症护理管理是一种临床上有用的策略，可使约50%的部分应答者完全缓解。
More than half of older adults respond only partially to first-line antidepressant pharmacotherapy. Our objective was to test the hypothesis that a depression-specific psychotherapy, Interpersonal Psychotherapy—IPT, when used adjunctively with escitalopram, would lead to a higher rate of remission and faster resolution of symptoms in partial responders than escitalopram with depression care management (DCM). We conducted a 16-week randomized clinical trial of IPT and DCM in partial responders to escitalopram, enrolling 124 outpatients aged 60 and older. The primary outcome, remission, was defined as three consecutive weekly scores of ≤7 on the Hamilton Rating Scale for Depression (17-item). We conducted Cox regression analyses of time to remission and logistic modeling for rates of remission. We tested group differences in Hamilton depression ratings over time via mixed-effects modeling. Remission rates for escitalopram with IPT and with DCM were similar in intention-to-treat (IPT versus DCM: 58 [95% CI: 46, 71] versus 45% [33,58]; p = 0.14) and completer analyses (IPT versus DCM: 58% [95% CI: 44,72] versus 43% [30, 57]; p = 0.20). Rapidity of symptom improvement did not differ in the two treatments. No added advantage of IPT over DCM was shown. Depression care management is a clinically useful strategy to achieve full remission in about 50% of partial responders.
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影响因子：
120.7
作者：
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通讯作者：
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DOI：
10.1093/geronb/63.4.p245
发表时间：
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影响因子：
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作者：
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通讯作者：
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