PROSPECTIVE STUDY ON THE TREATMENT AND PREDICTING EFFICACY IN REFRACTORY DEPRESSION

(1)重度抑郁障碍患者于入院4~7天及病情好转时进行促甲状腺激素释放激素(TRH)及地塞米松/促肾上腺皮质激素释放激素(DEX/CRH)联合检测。结果：上述指标均为阴性。入院时的测试与汉密尔顿抑郁量表(HRSD)或全球功能评估(GAF)相关。然而，由于ΔMAXACTH、ACTHAUC、ΔMAX皮质醇和皮质醇AUC在改善时与入院时相比显著下降。Δ-MAX-TSH无明显变化。在入院后3个月内预测改善是不可能的，单独使用任何一种测试都不可能。然而，ΔMAXACTH除以ΔMAXTSH商是临床改善的预测指标。(2)对重度抑郁障碍患者进行单光子发射计算机体层摄影术、高分辨睡眠呼吸暂停试验和GAF量表评估。其中19名患者在缓解期间也接受了同样的测试。结果：缓解期患者的整体脑血流量(GCBF)显著高于入选时。GCBF与年龄、抑郁发作持续时间、终生饮酒、精神运动发育迟缓和疑病症显著相关。然而，GCBF与HRSD、GAF、抑郁发作的严重程度和持续时间以及忧郁型抑郁症之间没有相关性。(3)抗抑郁药物治疗抵抗或不良反应导致的重度抑郁障碍患者不能接受足够剂量的药物治疗。结果：ECT的最终改善率与3次ECT完成时的改善率呈显著正相关，与ECT前药物治疗的充分性呈显著负相关。

(1)The patients with major depressive disorder received the Thyrotropin-releasing hormone (TRH) test and the combined dexamethasone/corticotropin-releasing hormone (DEX/CRH) test on the 4th through the 7th hospital days and at the time of improvement. Results : None of the indices in these. tests at the time of admission correlated with the Hamilton Rating Scale for Depression (HRSD) or the Global Assessment for Function (GAF). However, since the ΔMAXACTH, ACTHAUC, ΔMAXcortisol, and CortisolAUC showed significant decreases at the time of improvement compared with the time of admission. ΔMAXTSH showed no significant change. Prediction of improvement within 3 months after admission was not possible with either test alone. However, the quotient which divided ΔMAXACTH by ΔMAXTSH was predictive of clinical improvement.(2)Patients with major depressive disorder were evaluated using single photon emission computed tomography (SPECT), HRSD, and GAF scale. Nineteen of these patients also underwent the same tests during remission. Results : Global cerebral blood flow (gCBF) was significantly higher during remission than at the time of enrollment. Significant correlations were seen between gCBF and age, duration of previous episode of depression, lifetime alcohol consumption, psychomotor retardation, and hypochondriasis. However, no correlation was seen between gCBF and HRSD, GAF, severity and duration of depressive episode, or melancholia-type depression.(3)Subjects with major depressive disorder who were resistant to antidepressant therapy or who, due to adverse reactions, could not undergo pharmacotherapy at adequate doses for sufficient durations. Results : Significant positive correlations were seen between final improvement rate with ECT and improvement rate at completion of 3 ECT sessions, and significant negative correlations were seen between final improvement rate and adequacy of pharmacotherapy before ECT.