ENHANCING TREATMENT OUTCOMES IN DEPRESSION

改善抑郁症的治疗效果

• 批准号: 6330204
• 负责人: ANDREW F LEUCHTER
• 金额: $ 14.49万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 1994
• 资助国家: 美国
• 起止时间: 1994-12-01 至 2004-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6330204
• 关键词: antidepressants; behavioral /social science research tag; clinical depression; clinical research; electroencephalography; fluoxetine; human subject; human therapy evaluation; magnetic resonance imaging; mental disorder chemotherapy; outcomes research; positron emission tomography; prognosis; psychometrics

In this competing renewal application for a K02 award, Dr. Andrew Leuchter proposes a line of research and career enhancement aimed at improving outcomes of treatment for depression. Between 25 - 40 percent of patients with depression fail to respond to the first antidepressant prescribed, and these patients may suffer a protracted course of depression. Preliminary studies indicate that brain function measured with quantitative electroencephalographic (QEEG) cordance may be used prior to treatment, to predict which antidepressant medication is most likely to benefit an individual patient, as well as after treatment has started, to detect antidepressant effectiveness before symptoms improve. This application has three specific aims: 1) to verify the discriminative power of cordance in predicting and detecting treatment response for two antidepressants with different mechanisms of action; 2) to establish the relationship of cordance measurements to other putative predictors of antidepressant response, including cerebral metabolism and structure as well as clinical factors (age and symptom type); and, 3) in a developmental aim, to enhance Dr. Leuchter's skill in the areas of measuring treatment outcome and assessing the impact of predictors on treatment effectiveness. For his primary research study, Dr. Leuchter proposes a plan which will enroll 96 younger and older adult subjects in a double-masked protocol. Subjects will be treated with either fluoxetine 20/40 mg. or venlafaxine 150/225 mg., to determine whether cordance measurements are reliably associated with differential short-term response to antidepressant medications. Putative predictors of response such as pre- and post-treatment FDG-PET, volumetric MRI measurements, and clinical symptoms will be examined to identify the physiologic processes and structural features which contribute to the association between cordance and short-term treatment outcome. This study is part of an overall plan to enhance Dr. Leuchter's research activities and skills in interventions outcomes research. He will work with two consultants, Drs. Kenneth Wells and Lynn Fairbanks, to implement new methods and enhance his skills in intervention outcomes research. He will expand his research to include new methods to examine patterns of response, and will utilize additional functional outcome measures. In a developmental phase of this study, he also will initiate projects to examine the effectiveness of cordance and other putative predictors in improving long-term treatment outcomes. These effectiveness projects will include introduction of predictors into the usual treatment setting, and examination of cost-effectiveness and long-term treatment outcomes.

在这份K02奖项的竞争性续签申请中，安德鲁·勒赫特博士提出了一系列旨在改善抑郁症治疗结果的研究和职业提升。25%-40%的抑郁症患者对开出的第一种抗抑郁药没有反应，这些患者可能会经历漫长的抑郁症病程。初步研究表明，定量脑电(QEEG)Cordance测量的脑功能可用于在治疗前预测哪种抗抑郁药物最有可能对单个患者有利，以及在治疗开始后，在症状改善之前检测抗抑郁药物的有效性。这项应用有三个具体目的：1)验证Cordance在预测和检测两种作用机制不同的抗抑郁药的治疗反应时的辨别能力；2)建立Cordance测量与其他可能的抗抑郁反应预测指标的关系，包括大脑代谢和结构以及临床因素(年龄和症状类型)；以及3)在发展目标方面，提高Leuchter博士在衡量治疗结果和评估预测因素对治疗效果的影响方面的技能。在他的初步研究中，Leuchter博士提出了一项计划，将96名年轻和老年受试者纳入双掩蔽方案。受试者将接受氟西汀20/40毫克的治疗。或文拉法辛150/225毫克，以确定Cordance测量是否可靠地与抗抑郁药物的不同短期反应有关。治疗前和治疗后的FDG-PET、容量磁共振成像测量和临床症状等假定的反应预测因素将被检查，以确定有助于Cordance和短期治疗结果之间联系的生理过程和结构特征。这项研究是加强Leuchter博士在干预结果研究方面的研究活动和技能的总体计划的一部分。他将与肯尼斯·威尔斯博士和林恩·费尔班克斯博士两位顾问合作，实施新的方法，提高他在干预结果研究方面的技能。他将扩大他的研究，包括检查反应模式的新方法，并将利用额外的功能结果衡量标准。在这项研究的发展阶段，他还将启动项目，检查Cordance和其他假定的预测因素在改善长期治疗结果方面的有效性。这些有效性项目将包括在通常的治疗环境中引入预测因素，以及检查成本效益和长期治疗结果。