首发抑郁症抗抑郁药单药治疗的轨迹分析

摘要

Objective To analyze the treatment trajectory and revelant factors of serotonin reuptake inhibitors (SSRIs) in patients with first-episode major depression after single-drug treatment. And to provide ideas for early optimal treatment. Methods This study was a real-world study in which 82 untreated outpa-tients with first-episode depression were enrolled for SSRIs monotherapy. The Eysenck Personality Test (EPQ),the Liebowitz Social Anxiety Scale (LSAS),Yale -Brown Forced Scale (Y-BOCS),Social Function Deficit Scale (SDSS) were used to assess all patients at baseline. Then the patients were treated with SSRIs monotherapy. Patients who did not achieve a HAMD-17 20% reduction rate in the second week switched to receive another SSRIs monotherapy application. Follow-up to the 12th week to analyze treatment trajectory and identify factors associated with treatment trajectory. Results The psychotism personality trait ( B=-0. 287,95%CI=-0. 701~-0. 071,P=0. 009) and age ( B=0. 099,95%CI=0. 014~0. 244,P=0. 017) were related to treatment trajectories. The psychotism personality trait did not directly influence the treatment trajectory but influenced the treatment indirectly through agitation and the effect value was 0. 016,which ac-counted for 10. 76% of the total effect. Social anxiety and avoidance,depression,anxiety,obsessive-compul-sive symptoms and social dysfunction at baseline were not associated with antidepressant efficacy. Conclusion Psychoticism can predict the efficacy of antidepressants treatment as a mediator at the second week of treat-ment.%目的 分析首发抑郁症五羟色胺再摄取抑制剂(SSRIs)单药治疗后的治疗轨迹及其相关因素,为早期优化治疗提供思路.方法 本研究为真实世界研究,纳入门诊首发未治疗的抑郁症患者(n=82)进行SSRIs单药治疗,在基线对所有患者进行艾森克人格测验(EPQ)、Liebowitz社交焦虑量表(LSAS)、Yale-Brown强迫量表(Y-BOCS)、社会功能缺陷量表(SDSS)测评,采用SSRIs单药治疗,在第2周未达到HAMD-17 20%减分率者换用另一种SSRIs单药治疗,随访至第12周,分析治疗轨迹并寻找与治疗轨迹相关的因素.结果 精神质(B=-0. 287,95%CI=-0. 701~-0. 071,P=0. 009)和年龄(B=0. 099,95%CI=0. 014~0. 244,P=0. 017)治疗轨迹有关,精神质并非直接影响治疗轨迹而是透过激越作为中介变量影响治疗轨迹效应值为0. 016,占总效应的10. 96%.基线时社交焦虑与回避、抑郁、焦虑、强迫症状与社会功能缺陷均与抗抑郁药治疗轨迹无关. 结论 精神质以治疗第2周激越加重为中介因素预测抗抑郁药治疗中迁延波动的病程.