RAPID RESPONSE TO ANTIDEPRESSANTS BY SLEEP DEPRIVATION

虽然抗抑郁药物对大多数抑郁症患者有效， 延迟起效导致严重的并发症， 包括：（1）顺应性降低，（2）恢复正常的速度减慢 社会/职业功能，（3）增加自杀风险，（4） 增加住院费用;（5）延长住院时间 痛苦 因此，需要一种机动， 抗抑郁药的临床反应 一晚上的睡眠剥夺 (SD)已知能产生一种有效的，尽管是短暂的， 效果 本项目将研究延长《公约》 与丙咪嗪（IMI）组合对SD的反应。 此外该 下丘脑-垂体-甲状腺轴显著参与 情绪的调节，和这个系统的变化是已知的相关 回复SD 该项目的具体目标包括：（1） 比较三个治疗组对患者的抗抑郁作用 重度抑郁症患者：（a）IMI + SD，（B）单独SD，（c）单独IMI（至 测试IMI是否会将抗抑郁反应延长至SD）;（2） 评价甲状腺激素功能（即，促甲状腺激素，促甲状腺激素释放后促甲状腺激素最大值， T3、T4、FT 4指数、抗甲状腺抗体[ATA]和甲状腺结合 在SD之前和之后，用TBG来评估甲状腺功能是否 值与对SD的响应相关;（3）调查 SD反应和甲状腺活性与抗抑郁药的关系 第28天的治疗结果。 195名患有DSM的18-65岁抑郁症患者- III-R诊断重度抑郁症将进行为期五年的研究 期 患者将被随机分配到三个 治疗组。 初步评估后，患者将接受基线 甲状腺检测（包括T3、T4、TSH、ATA、TBG和TSH对TRH的反应）。 至少五天后，受试者将接受一晚的 观察到SD，第二天早上重复甲状腺检测。 然后将他们随机分为三个治疗组， 总共28天，同时在汉密尔顿评定量表上进行评定， 抑郁症，贝克抑郁症量表，和一个评级，特别是 为这个项目设计的睡眠障碍抑郁评定量表，在 基线和SD + 1 - 10、14、21和28天。 适当的统计 将进行比较，以评估具体目标。

Though antidepressant drugs are effective in most persons with depression, the delayed onset of action results in significant complications, including: (1) reduced compliance, (2) slowing of the return to normal social/ occupational functioning, (3) increasing the risk of suicide, (4) contributing to cumulative hospital costs, and (5) prolonging the duration of suffering. There is thus a need for a maneuver that would speed the clinical response to antidepressants. One night's whole sleep deprivation (SD) is known to produce a significant, albeit transient, antidepressant effect. This project will study the potential for the prolongation of the response to SD by combination with imipramine (IMI). In addition, the hypothalamic-pituitary-thyroid axis is significantly involved in the regulation of the mood, and changes in this system are known to be related to response to SD. The specific aims of the project include: (1) comparing the antidepressant effects of three treatment groups in patients with major depression: (a) IMI + SD, (b) SD alone, and (c) IMI alone (to test whether IMI will extend the antidepressant response to SD); (2) evaluating thyroid hormone function (i.e., TSH, delta max TSH after TRH, T3, T4, FT4-index, antithyroid antibodies [ATA], and thyroid binding globulin [TBG] before and after SD to assess whether thyroid function values are associated with response to SD; (3) investigating the relationship of both SD response and thyroid activity with antidepressant treatment outcome at day 28. 195 depressed persons aged 18-65 with a DSM- III-R diagnosis of major depression will be studied over a five year period. The patients will be randomly assigned to one of the three treatment groups. After initial assessment, patients will receive baseline thyroid testing (including T3, T4, TSH, ATA, TBG, and TSH response to TRH). After a minimum of five days, the subjects will undergo a one night's observed SD, with replication of the thyroid testing the next morning. They will then be randomized into the three treatment groups, and treated for a total of 28 days, while being rated on the Hamilton Rating Scale for Depression, the Beck Depression Inventory, and a rating specifically designed for this project the Sleep Deprivation Depression Rating Scale, at baseline and on SD + 1 - 10, 14, 21, and 28 days. Appropriate statistical comparisons will be made to evaluate the specific aims.