Baseline depression severity as a predictor of single and combination antidepressant treatment outcome: Results from the CO-MED trial
Baseline depression severity as a predictor of single and combination antidepressant treatment outcome: Results from the CO-MED trial
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DOI：
10.1016/j.euroneuro.2011.07.010
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发表时间：
2012-03-01
影响因子：
5.6
通讯作者：
Rush, A. John
中科院分区：
文献类型：
--
作者：
Friedman, Edward S.;Davis, Lori L.;Rush, A. John
本手稿的目的是报告基线抑郁严重程度与（1）基线社会人口统计学和临床特征，（2）治疗结局和（3）三个治疗组的不同结局之间的相关性。665例非精神病性重度抑郁症门诊患者前瞻性随机接受选择性5-羟色胺再摄取抑制剂（SSRI）单药治疗（艾司西酞普兰加安慰剂）或两种抗抑郁药联合治疗（安非他酮缓释剂加艾司西酞普兰，或文拉法辛缓释剂加米氮平）。出于这些分析的目的，根据16项抑郁症状快速量表-自我报告（QIDS-SR 16）总分的基线严重程度将参与者分为四组：轻度（0-10）[N=81]、中度（11-15）[N=238]、重度（16-20）[N=260]和非常重度（21-27）[N=67]。在12周和28周时，比较了四个严重程度组的治疗结果。童年忽视和/或虐待的历史与成年抑郁症的严重程度密切相关（非常严重组中1/2的参与者与轻度组中1/5-1/4的参与者报告了虐待和/或忽视）。自杀倾向的程度（例如，15/.4%的极重度组曾经试图自杀，而轻度组中没有），自杀企图的数量（例如，严重组中自杀企图的平均值为0.41 +/-1.99对轻度组中的0.0 +/-0.0）和自杀倾向的严重程度（例如，在非常严重的组中，9.2%的参与者有一个计划或做了一个手势，而在中度组中为5.6%，在轻度组中没有）在更严重的组中增加。基线抑郁严重程度更高的参与者报告了更多的精神病合并症（例如[在p
The objective of this manuscript is to report associations between baseline depressive severity and (1) baseline sociodemographic and clinical characteristics, (2) treatment outcomes, and (3) differential outcomes for three treatment groups. Six hundred and sixty-five outpatients with nonpsychotic, major depressive disorder were prospectively randomized to treatment with either a selective serotonin reuptake inhibitor (SSRI) monotherapy (escitalopram plus placebo) or one of two antidepressant medication combinations (bupropion-sustained release plus escitalopram, or venlafaxine-extended release plus mirtazapine). For purposes of these analyses, participants were divided into four groups based on baseline severity by the 16-item Quick Inventory of Depressive Symptomatology - Self-Report (QIDS-SR16) total score: mild (0-10) [N=81], moderate (11-15) [N=238], severe (16-20) [N=260] and very severe (21-27) [N=67]. Treatment outcomes at 12 and 28 weeks were compared among the four severity groups. A history of childhood neglect and/or abuse was strongly associated with the severity of adult depression (1/2 of participants in the very severe group versus 1/5-1/4 of those in the mild group reported abuse and/or neglect). The degree of suicidality (e.g., 15/.4% of the very severe group ever attempted suicide versus none in the mild group), the number of suicide attempts (e.g., mean of .41 +/- 1.99 suicide attempts in the severe group versus 0.0 +/- 0.0 in the mild group) and severity of suicidality (e.g., 9.2% of participants in very severe group had a plan or made a gesture versus 5.6% in moderate group and none in the mild group) were increased in more severe groups. Participants with a greater baseline depressive severity reported significantly more psychiatric comorbidities (e.g. [at p