老人憂鬱症抗憂鬱劑治療未緩解之預測因子：一個初步的開放式研究

Predictors of Non-remission for Antidepressant Treatment among the Elders with Major Depressive Disorder: A Preliminary Open-label Study

目的：由於症狀表現的複雜性，共病性以及病因，治療老年憂鬱症是極富挑戰性的。在 台灣，有關老年患鬱症病人的急性期治療結果與其相關因素之研究文獻數量未豐。我們進行 了十二週針對老年憂鬱症的抗憂鬱劑治療開放試驗，試圖檢驗不良預後的預測因子。方法： 收集六十位老年憂鬱症患者進行十二週急性抗憂鬱劑治療的開放試驗。使用17 項目的漢密爾 頓憂鬱量表(HAMD17)，分別於第0、2、4、8 和12 週進行憂鬱嚴重程度的評估。治療緩解的 定義分別是HAMD17 ≦ 7 和CGI ≦ 2。抗憂鬱劑則經由臨床判斷來處方。使用觀察值轉入(last observation carried forward) 來決定意圖治療群體(intention-to-treat population) 進行分析。 結果：在所有參與者中，每次達到緩解的病人所佔的比例分別為：第二週達15.4％，第4 週 達23.1％，第8 週達50％，以及第12 週達11.5％。我們發現，晚發性(late-onset) 的第一次 憂鬱症發作、高分數的情緒因素和睡眠因子，容易造成無法緩解(non-remitted)。結論：只有 40％的老年憂鬱病人完成十二週的急性治療試驗。近一半的研究對象可以達到緩解。晚發性 疾病、嚴重的憂鬱情緒與睡眠障礙，可能是無法緩解的預測因子，研究結果仍需未來以增加 樣本數、分組比較和隨機的研究設計來證實。

Background: Treatment for depressive elders is a challenge due to the complexity in clinical manifestation, medical comorbidity and etiologies. There has been scant of the literature regarding treatment outcomes and their correlates among the elderly patients with major depressive disorder at acute stage in Taiwan. We conducted a preliminary 12-week open-labeled trial of antidepressants for the late-life major depressive disorder, and examined the predictors of patients with poor outcome. Methods: Sixty elderly patients with late-life major depressive disorder were recruited for a 12-week open-labeled study of acute antidepressants treatment. Depressive severities were assessed using 17-item Hamilton Depression Rating Scale for Depression (HAMD17) at weeks, 0, 2, 4, 8, and 12-week. Treatment remission were defi ned by HAMD17 ≦7 and Clinical Global Inventory (CGI) ≦2. Antidepressants were prescribed according to clinical judgment. The intentto- treat population using the last observation carried forward (LOCF) method was used for analysis. Results: Among the patients achieving remission during the trial, the proportions of remitted patients of each visit were: 15.4% at the 2-week, 23.1% at the 4-week, 50% at the 8-week, and 11.5% at the 12-week. We found that the elderly patients with late-onset of fi rst major depressive episode, higher scores of mood factor, and sleep factor were likely to be non-remitted from antidepressant treatments. Conclusions: In this study, only 40% of elder patients could complete 12-week acute antidepressant treatments. Near half of all study participants reached remission. In summary, late-onset of the disease, severe depressed mood, and sleep disturbances could be the predictors for non-remission. But the study results need to be validated in future studies with larger sample sizes in the numbers of the study subjects as well as group comparation and randomization in design.