难治性抑郁的临床问题2008-4-7.ppt

* * * * * * * * * * * * 19.8％ 12.3％ Figure 2. Time to Remissiona for Outpatients With Nonpsychotic Major Depressive Disorder Randomly Assigned to Mirtazapine or Nortriptyline After Two Consecutive Failed Medication Treatments aScore 5 on the 16-item Quick Inventory of Depressive-Symptomatology–Self Rated. 在所接受的治疗策略范围内进行随机分组 米氮平 去甲替林 锂盐 T3 转换治疗 联合(增效)治疗 获得知情同意书 治疗策略是否接受? 退出研究 STAR*D第三阶段治疗选择 否 是 15.9% 24.7% 因不良反应脱落的更多 减分少 Nierenberg Figure 2. Cumulative Probability of Remissiona for Outpatients With Major Depressive Disorder Receiving Lithium or T3 Augmentation Treatment in STAR*D Level 3, by Time in Treatment aRemission was defined as the first score score ￡5 on the Quick Inventory of Depressive Symptomatology—Self-Report. 在所接受的治疗策略范围内进行随机分组 反苯环丙胺 文拉法新＋米氮平 转换治疗 获得知情同意书 治疗策略是否接受? 退出研究 STAR*D第四阶段治疗选择 否 是 13.7% 6.9% McGrath 因不良反应脱落的更多 减分值少 Figure 2. Cumulative Probability of Remissiona for Outpatients With Major Depressive Disorder Receiving Tranylcypromine or Venlafaxine (Extended-Release) and Mirtazapine in STAR*D Level 4, by Time in Treatment aRemission was defined as a score ￡5 on the Quick Inventory of Depressive Symptomatology—Self-Report. Rush AJ et al. Am J Psychiatry 163:11, 1905-1917, 2006 所有病例的累积临床痊愈率 (N= 3,671)* * Including those with HRSD-17<14 by ROA after enrollment QIDS-SR 临床痊愈率（%） 30.6 13.7 随访期患者的复发率（1年） Rush AJ et al. Am J Psychiatry 163:11, 1905-1917, 2006 完全缓解后 未完全缓解后 33.5% 58.6% Figure 3. Relapse During Follow-Up Phase by Number of Acute Treatment Steps for STAR*D Participants Who Entered Follow-Up Phase in Remissiona aSignificant overall difference among steps (2=23, df=3, p<0.0001). Significant post-hoc comparisons with Bonferroni corrections revealed significant differences between steps 1 and 2. STAR*D的主要结论 尽管经过急性期的积极治疗后只有1/3患者获得临床痊愈，但经过4个阶段治疗后的累积痊愈率为67％ 2个阶段治疗后有超过半数的患者获得临床痊愈，此后的治疗达到临床痊愈的可能性很小 慢性化、伴躯体疾病或其他精神障碍者需要更多次的治疗 临床痊愈者的预后更好 认知治疗与药物治疗的疗效相当，但起效较慢 有必要通过研究确定个体化的多步骤的治疗序列，开发广谱的有效药物 谢 谢 ! * * * * * * * * * * * * * * * * * * * * * * * 主要