2008年2月的愛(ài)思唯爾期刊《綜合醫(yī)院精神病學(xué)》（General Hospital Psychiatry）刊登了美國(guó)密歇根大學(xué)的一項(xiàng)最新研究,。研究表明，患有抑郁癥的病人通常服用抗抑郁藥物后會(huì)在初期有明顯改善,，但是對(duì)于有絕望癥狀的患者,，會(huì)影響其之后的藥物治療。
研究人員對(duì)573名抑郁癥患者進(jìn)行了抗抑郁藥物的研究,?；颊叻萌N抗抑郁藥物氟西汀，帕羅西汀和舍曲林中的一種,，同時(shí)對(duì)藥物療效的評(píng)定劃分為一個(gè)月,、三個(gè)月、六個(gè)月和九個(gè)月,。 整體上而言,，抑郁癥患者對(duì)藥物有著很快的反應(yīng)。68％的患者在最初的第一個(gè)月就有明顯改善,，有88％的患者在三個(gè)月后出現(xiàn)改善情況,。此外，患者在很多方面都出現(xiàn)了明顯的改變,，比如生活以及工作方面,。事實(shí)上，抑郁癥并不僅僅涉及到我們的情緒,，而是一個(gè)“全身性”的障礙,。它對(duì)患者的軀體和心理都具有極大的摧殘性。對(duì)有頭部,、背部和腹部疼痛的患者其在服用藥物的第一個(gè)月幾乎沒(méi)有改善,，正因?yàn)槿绱?，研究人員認(rèn)為醫(yī)生對(duì)此類(lèi)要考慮采取額外的治療來(lái)直接針對(duì)有疼痛的抑郁癥患者。
抑郁癥的常見(jiàn)癥狀有心情壓抑,、焦慮,、興趣喪失、精力不足,、悲觀失望,、絕望等。調(diào)查結(jié)果同時(shí)表明,，有些病人可能變成過(guò)分悲觀,，出現(xiàn)絕望的癥狀并由此停止繼續(xù)接受本來(lái)已經(jīng)有效的治療。研究人員認(rèn)為這一結(jié)果是令人擔(dān)憂,，因?yàn)榻^望是一個(gè)非常強(qiáng)會(huì)導(dǎo)致自殺的因素,。研究表明，有絕望癥狀的抑郁癥患者盡管他們的情況正在改善,，但有可能導(dǎo)致他們停止繼續(xù)服用藥物,，對(duì)于具有這類(lèi)者，其治療效果更為“循序漸進(jìn)”,。對(duì)于其治療,，研究人員認(rèn)為，應(yīng)考慮心理調(diào)節(jié)與藥物治療相結(jié)合的方法,。(科學(xué)網(wǎng) 于乃森 編譯)
生物谷推薦原始出處：
（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.
