Major depressive disorder and panic disorder. Effects of comorbidity on treatment outcome with antidepressant medications

Recent studies suggest that major depressive disorder (MDD) and panic disorder (PD) may coexist in a significant number of patients. The relevance of this association may be such that patients with the simultaneous diagnosis are at risk for more severe psychopathology and poorer treatment outcome. To explore this possibility further, we compared treatment outcome of two groups of patients: one with comorbidity of MDD and PD (N = 19) and another with MDD only (N = 22). Patients with comorbidity of MDD and PD scored significantly worse on a number of outcome assessments.     

抑郁障碍患者自杀未遂的危险因素分析

目的:分析抑郁障碍(MDD)患者自杀未遂的危险因素。方法:入组332例MDD患者,分为自杀未遂组(95例)和非自杀未遂组(237例);对入组者进行人口学与临床资料调查、汉密尔顿抑郁量表(HAMD-24)及汉密尔顿焦虑量表(HAMA-14)评估及血清甲状腺功能检测,并进行组间比较;分析自杀未遂的危险因素。结果:自杀未遂组年龄、首次发病年龄明显小于非自杀未遂组,病程、既往住院次数明显多于非自杀未遂组;单身、无业、受教育程度低、家族史阳性、伴有精神病性症状、共病焦虑障碍比率明显高于非自杀未遂组(P<0.05或P<0.01)。HAMD总分与焦虑躯体化、认知障碍、阻滞、绝望感、体质量、日夜变化因子分及HAMA评分明显高于非自杀未遂组(P<0.05或P<0.01)。血清游离三碘甲状腺原氨酸(FT3)水平明显高于非自杀未遂组(P<0.05)。多因素Logistic回归分析显示,伴有精神病性症状、既往住院次数、HAMD评分中认知障碍、绝望感因子是影响抑郁症患者自杀未遂的主要危险因素。结论:伴有精神病性症状、既往住院次数、HAMD评分中的认知障碍、绝望感因子可能为MDD患者...     

重性抑郁障碍患者出院后的服药依从性及其影响因素

目的 对出院重性抑郁患者的服药依从性进行评价并分析其影响因素.方法 选取2012年8月～2013年8月在唐山市第五医院住院符合DSM-Ⅳ重性抑郁障碍诊断的144例患者.在出院时对其进行一般情况、对自己服用抗抑郁药基本知识掌握情况、对抗抑郁药物的态度、对医生交流风格的评价等,在患者出院后第4、8、16周使用Morisky问卷对患者的依从性进行评价.探讨上述各因素对服药依从性的预测作用.结果 144例患者16周后的完全依从率为36.1％.完全依从组与部分依从组在年龄、婚姻状况、家属对患者服药的态度、是否知道药物的不良反应、是否知道抗抑郁药的作用机制、抗抑郁药物态度、医生交流风格评价等因素的差异有统计学意义（P＜0.05）,将是否为完全依从作为因变量,将以上项目作为自变量进行Logistic回归,结果显示抗抑郁药态度及是否知道抗抑郁药的作用机制2个变量进入方程,回归系数分别为2.323,1.205.结论 出院后重性抑郁症患者的服药依从性较低,对抗抑郁药的态度和抗抑郁药知识是服药依从性的影响因素.     

伴非典型特征的抑郁症患者自杀未遂的危险因素分析

目的探讨伴非典型特征抑郁症患者自杀未遂的社会人口学及临床特征方面危险因素。方法来自全国13个中心的1172例抑郁症患者,纳入其中179例伴非典型特征患者,依据简明国际神经精神访谈(the Mini International Neuropsychiatric Interview,MINI)5.0中文版自杀模块的访谈结果,分为自杀未遂组和无自杀未遂组,通过多因素logistic回归分析伴非典型特征的抑郁症患者在性别、年龄等社会人口学资料及伴焦虑症状、伴精神病性症状等临床特征方面可能与自杀未遂相关的危险因素。结果伴非典型特征抑郁症患者自杀未遂的发生率为23.5%(42/179)。与无自杀未遂组患者相比,自杀未遂组患者更多伴有自杀观念、产后起病,更常使用抗抑郁剂以外的其他药物治疗(如抗精神病药、情感稳定剂及苯二氮类药)(均P0.05)。多因素logistic回归分析显示,既往住院次数(OR=1.730,95%CI:1.093~2.740)和自杀观念(OR=3.899,95%CI:1.506~10.092)与伴非典型特征的抑郁症患者发生自杀未遂相关(均P0.05)。结论既往住院次数多及伴有自杀观念是伴非典型特征抑郁症患者自杀未遂的主要危险因素。     

Imaging the serotonin transporter during major depressive disorder and antidepressant treatment

This paper focuses on serotonin transporter 5-HTT imaging to investigate major depressive disorder (MDD) and antidepressant occupancy. Such investigations have only recently been possible as a result of major advances in ligand development. The state of the art method is [11C]DASB PET or [11C]-3-amino-4-(2-dimethylaminomethyl-phenylsulfanyl)-benzonitrile) positron emission tomography. [11C]DASB is a breakthrough for brain imaging 5-HTT. Compared with previous radioligands, [11C]DASB offers both high selectivity and a favourable ratio of specific binding relative to free and nonspecific binding. These characteristics contribute to valid, reliable quantitation of the 5-HTT binding potential (BP). The 5-HTT BP can be viewed as an index of 5-HTT density in a medication free state, or unblocked 5-HTT density in a medication-treated state. During major depressive episodes with no other axis I comorbidity, either no difference in regional 5-HTT BP or a trend toward elevated 5-HTT BP is typically found. During major depressive episodes (of MDD) with more severe symptoms of pessimism (dysfunctional attitudes), regional 5-HTT BP is elevated. In subjects with major depressive episodes and comorbid axis I psychiatric illnesses, decreased regional 5-HTT BP is often reported. With selective serotonin reuptake inhibitor (SSRI) treatment at doses that distinguish from placebo in the treatment of major depressive episodes, 5-HTT occupancy is approximately 80%, and there is a strong relation between plasma level and occupancy that is not predictable based on affinity alone. Implications of 5-HTT imaging findings for understanding major depressive disorder and antidepressant treatment will be discussed.     

Comparative study of suicide risk in depressive disorder patients with and without problem drinking

The present study sought to determine whether the co-occurrence of problem drinking heightens suicide risk in individuals with depression in Japan, using a sample of 784 outpatients (287 men and 497 women) with depressive disorder. Female subjects with at least a moderate problem drinking showed significantly more severe depression and suicidality than those without, but no such difference was identified in men.     

The effects of antidepressant treatment on resting‐state functional brain networks in patients with major depressive disorder

Although most knowledge regarding antidepressant effects is at the receptor level, the neurophysiological correlates of these neurochemical changes remain poorly understood. Such an understanding could benefit from elucidation of antidepressant effects at the level of neural circuits, which would be crucial in identifying biomarkers for monitoring treatment efficacy of antidepressants. In this study, we recruited 20 first‐episode drug‐naive major depressive disorder (MDD) patients and performed resting‐state functional magnetic resonance imaging (MRI) scans before and after 8 weeks of treatment with a selective serotonin reuptake inhibitor—escitalopram. Twenty healthy controls (HCs) were also scanned twice with an 8‐week interval. Whole‐brain connectivity was analyzed using a graph‐theory approach—functional connectivity strength (FCS). The analysis of covariance of FCS was used to determine treatment‐related changes. We observed significant group‐by‐time interaction on FCS in the bilateral dorsomedial prefrontal cortex and bilateral hippocampi. Post hoc analyses revealed that the FCS values in the bilateral dorsomedial prefrontal cortex were significantly higher in the MDD patients compared to HCs at baseline and were significantly reduced after treatment; conversely, the FCS values in the bilateral hippocampi were significantly lower in the patients at baseline and were significantly increased after treatment. Importantly, FCS reduction in the dorsomedial prefrontal cortex was significantly correlated with symptomatic improvement. Together, these findings provided evidence that this commonly used antidepressant can selectively modulate the intrinsic network connectivity associated with the medial prefrontal‐limbic system, thus significantly adding to our understanding of antidepressant effects at a circuit level and suggesting potential imaging‐based biomarkers for treatment evaluation in MDD. Hum Brain Mapp 36:768–778, 2015. © 2014 Wiley Periodicals, Inc.     

Impact of medical comorbid disease on antidepressant treatment of major depressive disorder

A major factor in evaluating and treating depression is the presence of comorbid medical problems. In this paper, the authors will first evaluate studies showing that medical illness is a risk factor for depression. The authors will review a series of randomized, controlled studies of antidepressant treatment in subjects with major depressive disorder (MDD) and comorbid medical illnesses (myocardial infarction, stroke, diabetes, cancer, and rheumatoid arthritis). Most of these studies report an advantage for an active antidepressant over placebo in improvement of depressive symptoms. The authors also will review a series of studies in which the outcome of antidepressant treatment is compared between subjects with MDD with and without comorbid medical illness. In these studies, subjects with medical illness tend to have lower improvement of depressive symptoms and higher rates of depressive relapse with antidepressant treatment compared with MDD subjects with no medical comorbidity. In addition, the authors will review hypotheses on the mechanism of the interaction between medical illness and clinical response in MDD. The paper will conclude that medical comorbidity is a predictor of treatment resistance in MDD.     

抑郁障碍患者楔前叶功能连接与抗抑郁药物早期疗效的相关性

背景 默认网络内楔前叶功能活动与抗抑郁药物的疗效有关。然而,楔前叶功能网络与抗抑郁药物早期疗效的关系仍不清楚。 目的 探索抑郁障碍患者楔前叶功能连接（FC）与抗抑郁药物早期疗效的关系,以期寻找预测抗抑郁药物早期疗效的神经生物标志物。 方法 连续纳入2017年7月—2019年2月在四川大学华西医院心理卫生中心就诊的、符合《精神障碍诊断与统计手册（第5版）》（DSM-5）诊断标准的47例抑郁障碍患者。采集患者基线期静息态功能磁共振（rs-fMRI）数据及临床信息。患者接受2周抗抑郁药物治疗,根据治疗2周时16项抑郁症状快速自评量表（QIDS-SR16）评分减分率是否≥20%,将患者分为早期改善组（ n=27）和未改善组（ n=20）。以双侧楔前叶为种子点,计算楔前叶与全脑FC值,比较两组基线期楔前叶FC的差异。采用Pearson相关分析考查差异有统计学意义的脑区的FC值与QIDS-SR16评分及其减分率之间的相关性。 结果 早期改善组左侧楔前叶与左侧中央前回的FC值、右侧楔前叶与右侧梭状回的FC值均高于未改善组（GRF校正, P<0.01）。抑郁障碍患者左侧楔前叶与左侧中央前回的FC值、右侧楔前叶与右侧梭状回的FC值与QIDS-SR16总评分减分率均呈正相关（ r=0.475、0.297, P均<0.05）。 结论 基线期较低的左侧楔前叶与左侧中央前回、右侧楔前叶与右侧梭状回的FC与较差的抗抑郁药物早期疗效有关,楔前叶FC可能是预测抗抑郁药物早期疗效的潜在指标。     

重性抑郁障碍患者药物治疗反应相关自发性神经活动改变的Meta分析

目的探索重性抑郁障碍(MDD)患者与药物治疗反应相关的自发性神经活动改变,寻找与治疗反应相关的影像学指标。方法计算机检索中国知网数据库、万方数据库、维普数据库、PubMed、Embase和Web of Science数据库,收集与MDD患者治疗反应相关的静息态脑功能影像研究,使用AES-SDM进行Meta分析。结果共8篇文章纳入Meta分析,包括288例患者和304例健康对照组。Meta分析结果显示,与健康对照组相比,治疗有效的MDD患者左侧小脑(峰值坐标:X=-22,Y=-78,Z=-18,SDM-Z=1.458)、左侧颞叶(峰值坐标:X=-50,Y=-30,Z=-8,SDM-Z=1.539)及右侧角回(峰值坐标:X=48,Y=-66,Z=36,SDM-Z=1.536)的脑功能活动增加,左侧辅助运动区(峰值坐标:X=-10,Y=-2,Z=72,SDM-Z=-1.107)脑功能活动降低;治疗无效的MDD患者双侧额上回、前扣带回(峰值坐标:X=12,Y=42,Z=-4,SDM-Z=1.526)脑功能活动增加,左侧额下回(峰值坐标:X=-48,Y=16,Z=6,SDM-Z=-1.912)脑功能活动降低。结论小脑半球自发性神经活动的改变可能成为预测MDD患者治疗反应的影像学指标。     

未治疗抑郁障碍患者自杀风险与认知情绪调节策略的关系

目的探讨具有自杀风险的抑郁障碍患者在认知情绪调节策略方面的特征及其影响因素,以早期识别具有自杀风险的患者,有针对性地给予干预。方法选取117例来自北京回龙观医院门诊、经简明国际神经精神访谈(MINI)5. 0中文版筛查符合抑郁障碍诊断标准的未治疗抑郁障碍患者,根据MINI 5. 0中文版自杀模块的访谈结果,将患者分为自杀风险组(n=52)和无自杀风险组(n=65)。采用认知情绪调节问卷(CERQ-C)进行认知调节策略的测评,采用汉密尔顿抑郁量表17项版(HAMD-17)评定抑郁症状的严重程度。结果抑郁障碍患者自杀风险发生率为44. 4%(52/117)。与无自杀风险组相比,自杀风险组患者更多见于女性、未婚、平均年龄更小、发病年龄更早、HAMD-17总评分更高、伴精神病性症状率较高,自杀风险组自我责难、接受、沉思、灾难化4个认知调节策略维度及消极认知情绪调节评分均高于无自杀风险组(P均<0. 05)。Logistic回归分析显示,女性(OR=3. 539,95%CI:1. 383~9. 057)、发病年龄(OR=0. 931,95%CI:0. 895~0. 968)、HAMD-17总评分(OR=1. 207,95%CI:1. 063~1. 370)和灾难化(OR=1. 143,95%CI:1. 002~1. 305)与抑郁障碍患者自杀风险相关(P均<0. 05)。结论女性、发病年龄早、抑郁症状严重和灾难化可能为未治疗抑郁障碍患者自杀风险的危险因素。     

Topological network mechanisms of clinical response to antidepressant treatment in drug-naive major depressive disorder

AimThere is rapidly increasing evidence that remission of MDD is associated with substantial changes in functional brain connectivity. These New data have provided a holistic view on the mechanism of antidepressants on multiple levels that goes beyond their conventional effects on neurotransmitters.MethodThe study was approved by the Local Ethics Committee of Istanbul Medipol University (10840098-604.01.01-E.65129) and followed the Helsinki Declaration principles. In our study, we have evaluated the effect of six weeks of treatment with antidepressants (escitalopram and duloxetine), and tested the underlying brain functional connectivity through a Graph analysis approach in a well-defined first-episode, drug-naive, and non-comorbid population with MDD.ResultsBeyond indicating that there was a significant correlation between the antidepressant response and topological characteristics of the brain, our results suggested that global rather than regional network alterations may be implicated in the antidepressant effect.ConclusionDespite the small-sample size and non-controlled study design, our study provides important and relevant clinical data regarding the underlying mechanisms of the antidepressants on topological dynamics in the human brain.