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Do baseline sub-threshold hypomanic symptoms affect acute-phase antidepressant outcome in outpatients with major depressive disorder? Preliminary findings from the randomized CO-MED trial.
Neuropsychopharmacology ( IF 7.6 ) Pub Date : 2018-10-01 , DOI: 10.1038/s41386-018-0180-z
Manish K. Jha , Ashley L. Malchow , Bruce D. Grannemann , A. John Rush , Madhukar H. Trivedi

Sub-threshold hypomanic symptoms are common in major depressive disorder. This study evaluated the prevalence, the clinical and sociodemographic correlates, and the overall and differential effects of the presence/absence of sub-threshold hypomanic symptoms at baseline on acute-phase treatment outcomes with bupropion-plus-escitalopram combination, escitalopram monotherapy, and venlafaxine-plus-mirtazapine combination. Combining medications to enhance depression outcomes (CO-MED) trial participants (n = 665) were designated as sub-threshold hypomanic symptoms present (Altman Self-Rating Mania Scale score (ASRM) ≥ 1) or absent (ASRM = 0) and compared on clinical and sociodemographic features and remission rates. Participants with sub-threshold hypomanic symptoms (n = 335/665, 50.4%) were more likely to be black and non-Hispanic, have comorbid medical and psychiatric disorders, experience longer index episodes, and report lower depression severity and psychosocial impairment. Intent-to-treat remission rates were lower overall (absent = 42.7%, present = 34.0%, p = 0.02), with escitalopram monotherapy (absent = 45.8%, present = 31.6%, p = 0.03), and with venlafaxine-XR-plus-mirtazapine combination (absent = 44.4%, present = 30.1%, p = 0.03) but not with bupropion-plus-escitalopram combination (absent = 37.7%, present = 40.0%, p = 0.73). Participants without sub-threshold hypomanic symptoms were more likely to remit than those with such symptoms overall [odds ratio (OR) = 1.49], with escitalopram monotherapy (OR = 1.71), and with venlafaxine-plus-mirtazapine combination (OR = 1.97) but not with bupropion-plus-escitalopram combination (OR = 0.96), even after controlling for baseline depression severity, psychosocial impairment, and number of comorbid psychiatric disorders. Sub-threshold hypomanic symptoms (found in about 50% of patients in this report) were associated with lower remission rates with escitalopram monotherapy and with venlafaxine-plus-mirtazapine combination but not with the bupropion-plus-escitalopram combination.

中文翻译:

基线亚阈低躁狂症状是否会影响重度抑郁症门诊患者的急性抗抑郁预后?随机CO-MED试验的初步发现。

亚阈低躁狂症状在重度抑郁症中很常见。本研究评估了安非他酮加依西酞普兰联合治疗,依西酞普兰单药治疗和文拉法辛的急性期治疗结局,基线时亚阈以下躁狂症状的患病率,临床和社会人口学相关因素以及总体和差异性影响加米氮平组合。合并药物以增强抑郁预后(CO-MED)的试验参与者(n = 665)被指定为存在亚阈值躁狂症状(Altman自评躁狂量表评分(ASRM)≥1)或不存在阈下躁狂症状(ASRM = 0)并进行比较临床和社会人口统计学特征和缓解率。亚阈低躁狂症状(n = 335 / 665,50.4%)的参与者更可能是黑人和非西班牙裔,患有合并症的医学和精神疾病,经历更长的指数发作,并报告抑郁症严重程度和社会心理损害较低。意法治疗的总体缓解率较低(不存在= 42.7%,当前= 34.0%,p = 0.02),依西酞普兰单药治疗(不存在= 45.8%,当前= 31.6%,p = 0.03),以及文拉法辛-XR -加-米氮平联合用药(不存在= 44.4%,当前= 30.1%,p = 0.03),但不与安非他酮加-依他普仑组合(不存在= 37.7%,当前= 40.0%,p = 0.73)。与总体症状[比值比(OR)= 1.49],依西酞普兰单药治疗(OR = 1.71)和文拉法辛加米氮平联合治疗(OR = 1.97)相比,无亚阈值低躁狂症状的参与者更有可能缓解。但不能与安非他酮加依他普仑组合使用(OR = 0.96),即使在控制了基线抑郁症的严重程度,社会心理障碍和合并精神疾病的数量之后也是如此。亚阈值轻躁狂症状(在本报告中约有50%的患者中发现)与艾司西酞普兰单药治疗,文拉法辛加米氮平联合治疗的缓解率降低相关,但与安非他酮加依西酞普兰联合治疗无效。
更新日期:2018-08-15
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