在OPTIMUM随机对照试验中,抗抑郁药物增强与切换的调节者
Helena K Kim1, Jordan F Karp2, Helen Lavretsky3
1Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
概括
对治疗耐药性抑郁症 (TRD) 和不到三次先前抗抑郁药试验的老年人来说,增加治疗比切换更好. 在三次或更多次尝试后,考虑其他策略.
科学领域:
- 老年精神病学是一门精神病学专业.
- 药理干预措施 药理干预措施
- 治疗耐药性抑郁症的治疗方法
背景情况:
- 患有治疗耐药性抑郁症 (TRD) 的老年人通常从治疗增强中获益更多,而不是转换抗抑郁药.
- 识别主持人对于个性化TRD管理中的治疗策略至关重要.
研究的目的:
- 调查是否年龄,执行功能障碍,医疗负担,焦虑或先前的抗抑郁药试验数量可以缓解TRD的老年人中增强与切换的有效性.
- 确定影响增强和切换策略之间的差异结果的因素.
主要方法:
- 对来自"优化老年人治疗耐药抑郁症结果" (OPTIMUM) 随机对照试验 (N=742) 的数据进行了预先计划的适度分析.
- 60岁以上患有TRD的参与者被随机分配到抗抑郁药物增强剂 (aripiprazole, bupropion或) 或切换剂 (bupropion或nortriptyline) 在10周内.
- 测量结果包括症状改善 (MADRS分数的变化) 和缓解 (MADRS ≤10).
主要成果:
- 之前有足够的抗抑郁药试验的数量显著缓解了抑郁症症状的改善 (P=0.033).
- 增强仅在老年患者中优于切换,之前的抗抑郁药试验少于三次.
- 没有其他测试的调节者 (年龄,执行功能障碍,医疗负担,焦虑) 显示出显著的影响.
结论:
- 治疗增强在TRD的老年人中比切换更优越,这些老年人以前接受过不到三次抗抑郁药试验.
- 对于之前有三次或更多抗抑郁药试验的患者,应考虑替代干预策略.
- 这一发现支持个性化治疗方法在老年人群中治疗耐治疗抑郁症的管理.
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