Am J Psychiatry：老年抑郁症转归的调节因素

　　一项最新的患者水平荟萃分析表明，与安慰剂组相比，年龄越大，疾病持续时间长，中到重度抑郁症的患者似乎从抗抑郁药物治疗中获益。抗抑郁药物治疗似乎对于年龄较大疾病持续时间较短的患者无效。该研究于2013年4月19日在线发表在《美国精神病学杂志》上（10.1176/appi.ajp.2012.12070927）。

　　该研究旨在确定调节老年重性抑郁症转归的因素并确定抗抑郁药对哪些患者具有临床疗效。

　　先前的一篇系统性综述确定了10项在60岁或60岁以上的重性抑郁症门诊患者中应用二代抗抑郁药的安慰剂对照试验。在本研究中，研究人员从那10项研究的发起人那里获取患者的个人信息数据，包括年龄、性别、疾病持续时间（当前年龄减去发病时的年龄），病程（单次发作或反复抑郁），基线抑郁严重程度，治疗安排和转归。通过评价并校正罗杰斯回归模型来检测潜在调节变量和治疗反应的联系以及治疗组-反应相互作用。

　　研究人员共收集并记录了10项研究中7项的所有调节变量（N=2,283）。单变量和多变量分析都限于这7项研究。在多变量模型中，只有疾病持续时间这个变量与药物-安慰剂间的差异显著相关。疾病持续时间10年或以上的患者，基线抑郁严重程度也与药物-安慰剂间的差异显著相关。疾病持续时间10年或以上且汉密顿抑郁量表评分≥21者，在反应率方面，药物-安慰剂间的差异相对较大。剩余的患者中，在反应率方面，药物-安慰剂间的差异较小。

与抑郁相关的拓展阅读：

• Eur J Prev Cardiol：生活方式干预延缓抑郁症状进展
• J Med Life：1型糖尿病合并抑郁者转归较差
• ADAA：应用氯胺酮抗抑郁 时机尚不成熟
• ADAA：抗抑郁药联合认知行为疗法对老年焦虑效果好
• 初诊抑郁症与动脉粥样硬化相关 更多信息请点击：有关抑郁更多资讯

Moderators of Outcome in Late-Life Depression: A Patient-Level Meta-Analysis.
OBJECTIVE
The authors sought to identify factors that moderate outcome in late-life major depression and that identify patients for whom antidepressants have clinically meaningful effects.
METHOD
A previous systematic review identified 10 placebo-controlled trials of second-generation antidepressants in outpatients with major depressive disorder who were age 60 or older. For the present study, the authors obtained from the sponsors of the 10 trials individual patient data, including age, sex, duration of illness (current age minus age at onset), course (single episode or recurrent depression), baseline depression severity, treatment assignment, and outcomes. Logistic regression models were estimated and tested to examine the association of potential moderator variables with treatment response and the treatment group-response interaction.
RESULTS
All moderator variables were collected and documented for seven of the 10 trials (N=2,283). Univariate and multivariate analyses were restricted to these seven trials. Illness duration was the only variable significantly associated with drug-placebo differences in the multivariate model. In patients with an illness duration >10 years, baseline depression severity was also significantly associated with drug-placebo differences. In those with an illness duration >10 years and a Hamilton Depression Rating Scale score ≥21, the drug-placebo difference in response rates was relatively robust (number needed to treat=4). In the remaining patients, the drug-placebo difference in response rates was small (46.3% compared with 41.5%).
CONCLUSIONS
Older patients with a long illness duration and moderate to severe depression appear to benefit from antidepressants as compared with placebo. Antidepressants do not appear to be effective for older patients with short illness duration.