Recurrence after recovery from major depressive disorder during 15 years of observational follow-up.
Recurrence after recovery from major depressive disorder during 15 years of observational follow-up.
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DOI：
10.1176/ajp.156.7.1000
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发表时间：
1999-07
期刊：
影响因子：
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通讯作者：
T. Mueller;A. Leon;M. Keller;D. Solomon;J. Endicott;W. Coryell;M. Warshaw;J. Maser
中科院分区：
文献类型：
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作者：
T. Mueller;A. Leon;M. Keller;D. Solomon;J. Endicott;W. Coryell;M. Warshaw;J. Maser
目的：使用美国国家精神卫生研究所抑郁症心理生物学临床研究合作项目中独特的纵向前瞻性随访数据，对最初从重性抑郁症中康复的人的情感障碍复发进行表征。方法长达15年的前瞻性随访数据的过程中，抑郁症的380例受试者从指数发作的抑郁症和105例受试者谁随后保持良好至少5年后恢复。基线人口统计学和临床特征作为情感性精神障碍复发的预测因素进行了研究。作者还研究了自然应用的抗抑郁治疗。结果380例康复受试者中有85%（Kaplan-Meier估计）的累积比例复发，58%（Kaplan-Meier估计）的患者至少保持5年。女性，更长的抑郁发作前摄入量，更多的前期发作，从未结婚是复发的显着预测因素。这些或任何其他特征均不能持续作为已恢复且随后至少5年良好的受试者复发的预测因素。受试者报告在索引发作期间接受低水平的抗抑郁药治疗，在井间隔期间其数量和程度进一步降低。结论：很少有基线人口统计学或临床特征预测谁会或不会经历一个从指数发作的重性抑郁症恢复后的情感障碍复发，即使是在人与长时间的休息。抗抑郁药治疗的自然应用水平远低于维持药物治疗研究中显示的有效水平。
OBJECTIVE The recurrence of an affective disorder in people who initially recover from major depressive disorder was characterized by using the unique longitudinal prospective follow-up data from the National Institute of Mental Health Collaborative Program on the Psychobiology of Depression-Clinical Studies. METHOD Up to 15 years of prospective follow-up data on the course of major depressive disorder were available for 380 subjects who recovered from an index episode of major depressive disorder and for 105 subjects who subsequently remained well for at least 5 years after recovery. Baseline demographic and clinical characteristics were examined as predictors of recurrence of an affective disorder. The authors also examined naturalistically applied antidepressant therapy. RESULTS A cumulative proportion of 85% (Kaplan-Meier estimate) of the 380 recovered subjects experienced a recurrence, as did 58% (Kaplan-Meier estimate) of those who remained well for at least 5 years. Female sex, a longer depressive episode before intake, more prior episodes, and never marrying were significant predictors of a recurrence. None of these or any other characteristic persisted as a predictor of recurrence in subjects who recovered and were subsequently well for at least 5 years. Subjects reported receiving low levels of antidepressant treatment during the index episode, which further decreased in amount and extent during the well interval. CONCLUSIONS Few baseline demographic or clinical characteristics predict who will or will not experience a recurrence of an affective disorder after recovery from an index episode of major depressive disorder, even in persons with lengthy well intervals. Naturalistically applied levels of antidepressant treatment are well below those shown effective in maintenance pharmacotherapy studies.