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首页> 外文期刊>The journal of clinical psychiatry >Depression-free days as a summary measure of the temporal pattern of response and remission in the treatment of major depression: a comparison of venlafaxine, selective serotonin reuptake inhibitors, and placebo.
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Depression-free days as a summary measure of the temporal pattern of response and remission in the treatment of major depression: a comparison of venlafaxine, selective serotonin reuptake inhibitors, and placebo.

机译：无抑郁日可作为衡量严重抑郁症反应和缓解的时间模式的简要指标：文拉法辛，选择性5-羟色胺再摄取抑制剂和安慰剂的比较。

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BACKGROUND: This article develops and applies depression-free days (DFDs) as a summary measure of the temporal pattern of response and remission in a comparison of venlafaxine (a dual-action serotonin-norepinephrine reuptake inhibitor) with selective serotonin reuptake inhibitors (SSRIs) and placebo. METHOD: Weekly data on the 17-item Hamilton Rating Scale for Depression (HAM-D-17) from 2046 patients with DSM-III-R/IV-established moderate-to-severe major depression, participating in 1 of 8 randomized, double-blind, controlled studies that compared venlafaxine with an SSRI (fluoxetine, paroxetine, or fluvoxamine) or with both placebo and an SSRI, were used to estimate DFDs. Maximum DFDs were imputed to maintained HAM-D-17 scores < or = 7 (asymptomatic depression) over time, minimum DFDs to persistent HAM-D-17 scores > or = 15 (acutely symptomatic depression), and prorated DFDs to intermediate HAM-D-17 scores. A secondary construct was developed to test sensitivity to a less stringent upper threshold of acutely symptomatic depression (HAM-D-17 score > or = 22). Using a tertiary construct, sensitivity to a more stringent lower threshold representing elimination of residual symptoms was also evaluated. The construct validity of the primary and the secondary DFDs measures was assessed in terms of their correlation with sustained low clinical global severity of illness (scores of 1 or 2 on the Clinical Global Impressions-Severity of Illness scale). for each construct, DFDs were compared across the 3 treatment groups and corresponding effect sizes were generated. RESULTS: Overall, sustained low clinical global severity of illness was associated with 38.3 median (interquartile range, 29.8 to 44.2) DFDs relative to 5.7 (interquartile range, 0 to 20.6) median DFDs associated with nonsustained low clinical global severity; similar differences emerged in terms of sustained asymptomatic depression. The venlafaxine group (N = 851) experienced a median of 18.8 (interquartile range, 0.4 to 34.6) DFDs compared with a median of 13.6 (interquartile range, 0 to 29.8) DFDs in the SSRI group (N = 749) and 7.4 (interquartile range, 0 to 26.2) DFDs in the placebo group (N = 446) (p <.0001 overall; venlafaxine vs. SSRIs, p =.0015, effect size = 0.2; venlafaxine vs. placebo, p <.0001, effect size = 0.4; and SSRIs vs. placebo, p =.0007, effect size = 0.2). The secondary and tertiary DFDs constructs yielded similar, albeit narrower, differences in all comparisons. CONCLUSION: The construct of DFDs was found to be a useful summary measure of sustained remission. Active treatments were associated with more DFDs than placebo, and venlafaxine with more DFDs than SSRIs, consistent with corresponding differences in sustained remission.
机译：背景：本文开发和应用无抑郁日（DFDs）作为反应和缓解的时间模式的汇总量度，用于比较文拉法辛（一种双重作用的5-羟色胺-去甲肾上腺素再摄取抑制剂）与选择性5-羟色胺再摄取抑制剂（SSRIs）和安慰剂。方法：每周数据来自2046例DSM-III-R / IV建立的中度至重度严重抑郁症患者的17项汉密尔顿抑郁量表（HAM-D-17），参与8随机，双将文拉法辛与SSRI（氟西汀，帕罗西汀或氟伏沙明）或安慰剂和SSRI进行比较的盲法，对照研究被用于估计DFD。随着时间的推移，将最大DFD推定为维持HAM-D-17得分<或= 7（无症状抑郁），将最小DFD推定为持续的HAM-D-17得分>或= 15（急性症状性抑郁），并按比例分配DFD到中等HAM-D-17。 D-17得分。开发了第二种构建体以测试对急性症状性抑郁症的较低严格上限（HAM-D-17得分>或= 22）的敏感性。使用第三构造，还评估了对代表消除残留症状的更严格的较低阈值的敏感性。根据主要DFD和次要DFD措施与持续较低的临床总体疾病严重程度（临床总体印象-疾病严重程度评分为1或2）的相关性来评估其结构效度。对于每种构建体，将3个治疗组的DFD进行比较，并产生相应的效应大小。结果：总体而言，持续的低临床总体疾病严重度与38.3中位数（四分位数范围，29.8至44.2）DFD相关，相对于5.7（四分位数范围，0至20.6）中值DFD与未持续的低临床总体严重度相关;在持续无症状抑郁方面也出现了类似的差异。文拉法辛组（N = 851）的DFD中位数为18.8（四分位数范围，0.4至34.6），而SSRI组（N = 749）和7.4（四分位数）中位数为13.6（四分位数范围，0至29.8）范围（0到26.2））安慰剂组中的DFD（N = 446）（总体p <.0001;文拉法辛与SSRIs，p = .0015，效应量= 0.2;文拉法辛与安慰剂，p <.0001，效应量= 0.4; SSRI与安慰剂的比较，p = .0007，效果大小= 0.2）。在所有比较中，第二级和第三级DFD构造均产生相似但较窄的差异。结论：DFDs的构建被发现是一种持续缓解的有用的简易措施。与安慰剂相比，积极治疗与更多的DFD相关，与SSRI相比，文拉法辛具有更多的DFD，与持续缓解的相应差异一致。

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