2008-3-12 10:40:33

抑郁患者的绝望症状影响药物治疗

2008年2月的爱思唯尔期刊《综合医院精神病学》（General Hospital Psychiatry）刊登了美国密歇根大学的一项最新研究。研究表明，患有抑郁症的病人通常服用抗抑郁药物后会在初期有明显改善，但是对于有绝望症状的患者，会影响其之后的药物治疗。

研究人员对573名抑郁症患者进行了抗抑郁药物的研究。患者服用三种抗抑郁药物氟西汀，帕罗西汀和舍曲林中的一种，同时对药物疗效的评定划分为一个月、三个月、六个月和九个月。整体上而言，抑郁症患者对药物有着很快的反应。68％的患者在最初的第一个月就有明显改善，有88％的患者在三个月后出现改善情况。此外，患者在很多方面都出现了明显的改变，比如生活以及工作方面。事实上，抑郁症并不仅仅涉及到我们的情绪，而是一个“全身性”的障碍。它对患者的躯体和心理都具有极大的摧残性。对有头部、背部和腹部疼痛的患者其在服用药物的第一个月几乎没有改善，正因为如此，研究人员认为医生对此类要考虑采取额外的治疗来直接针对有疼痛的抑郁症患者。

抑郁症的常见症状有心情压抑、焦虑、兴趣丧失、精力不足、悲观失望、绝望等。调查结果同时表明，有些病人可能变成过分悲观，出现绝望的症状并由此停止继续接受本来已经有效的治疗。研究人员认为这一结果是令人担忧，因为绝望是一个非常强会导致自杀的因素。研究表明，有绝望症状的抑郁症患者尽管他们的情况正在改善，但有可能导致他们停止继续服用药物，对于具有这类者，其治疗效果更为“循序渐进”。对于其治疗，研究人员认为，应考虑心理调节与药物治疗相结合的方法。(科学网于乃森编译)

生物谷推荐原始出处：

（General Hospital Psychiatry），doi:10.1016/j.genhosppsych.2007.10.003，James E. Aikens, Ananda Sen

Trajectories of improvement for six depression-related outcomes

James E. Aikens Ph.D., Kurt Kroenke M.D. Donald E. Nease Jr. M.D. Michael S. Klinkman M.D., M.S. and Ananda Sen Ph.D.

Abstract

Objective

Although depression treatment improves diverse outcomes, it is unclear whether these improvements are comparable in magnitude and timing. The objective was therefore to compare treatment-related improvements in depressive symptoms, work and social functioning, hopefulness, somatic complaints and positive well-being.

Method

Secondary analysis of a large clinical trial of selective serotonin reuptake inhibitors for primary care depression. Depressed patients (n=573) from 37 practices from two primary care networks were randomized to fluoxetine, paroxetine or sertraline, and then followed naturalistically. At 1, 3, 6 and 9 months after treatment initiation, assessments were made of depressive symptom severity, social and work functioning, positive well-being, hopefulness beliefs and somatic complaints. Data were analyzed with linear regression modeling.

Results

Although 68% and 88% of total mood improvement occurred by Months 1 and 3, respectively, improvement plateaued sooner for somatic complaints (P=.001 at Month 1), and more gradually for hopefulness [P (Month 1)=.015, P (Month 3)=.036]. Although magnitude of improvement was interrelated across outcomes, timing of mood improvement was unrelated to the timing of improvement in both somatic complaints and hopefulness. Improvement in somatic complaints was primarily attributable to improvements in head, back and stomach pain.

Conclusions

Work and social functioning, and positive affect improve synchronously with mood. Compared to mood, improvement in pain complaints peaks earlier, whereas improvement in hopefulness is much more linear over time. Because depression treatment response appears to be complex and multidimensional, a broader conceptualization of depression remission may be indicated.