Title

老年憂鬱症對抗憂鬱劑之療效及預後相關因素之探討

Translated Titles

The Investigation of Response to Antidepressant and the Related Factors of Prognosis in Geriatric Depression

DOI

10.6834/CSMU.2007.00033

Authors

賴德仁

Key Words

老年憂鬱症 ; 抗憂鬱劑 ; 治療反應 ; geriatric depression ; antidepressant ; treatment response

PublicationName

中山醫學大學醫學研究所學位論文

Volume or Term/Year and Month of Publication

2007年

Academic Degree Category

博士

Advisor

周明智

Content Language

繁體中文

Chinese Abstract

隨著台灣老年人口快速增加,老年憂鬱症已成為老年精神醫學及公共衛生領域重要的課題。本研究是一個觀察型研究,探討老年憂鬱症患者接受抗憂鬱劑(sertraline)治療三個月後,何種因子會影響治療反應。本研究是以中山醫學大學附設醫院及台中榮民總醫院精神科門診的老年病患為研究對象,診斷符合DSM-IV 重鬱症診斷準則並排除失智症之病患,給予相同的抗憂鬱劑(sertraline)持續治療三個月,比較病人之治療反應、認知功能、同時罹患之精神疾病、腦部核磁共振影像檢查(MRI)、免疫與生化數值、生活品質與主要照顧者之生活品質及照顧者負擔等。測驗工具包括:基本資料、Mini-Mental State Examination (MMSE)、Hamilton Depression Rating Scale (HDRS) 、MINI International Neuropsychiatric Interview 等。在治療前及治療後第三個月抽血測量免疫指標和免疫及生化數值,以及施測神經心理學測驗,而MRI 則在治療之初完成。病患及主要照顧者同時接受世界衛生組織生活品質問卷—台灣簡明版之評估,主要照顧者另外接受照顧者負擔量表之評估。統計分析由於個案數少於30,所以以無母數分析之(使用Mann-Whitney test 在數值變數;治療前後之比較則使用Wilcoxon Signed Ranks test;使用Fisher’s exact test 在類別變數),比較不同之老年憂鬱症患者之各類人口學資料、免疫指標、生化數值、腦部損傷、其他精神疾病之共病情形、認知障礙、生活品質及各種量表之結果是否有統計差異。以治療滿4週之緩解組與未緩解組、治療滿4週之反應組與未反應組、治療滿12週之緩解組與未緩解組、治療滿12週之反應組與未反應組分別比較以上各因子之差異性。另外分別以服藥滿4週及服藥滿12週之療效作為依變項,將可能影響療效之因子作單變項邏輯迴歸分析。 結果共收集37名老年憂鬱症患者,其中有29名老年憂鬱症患者完成12週之治療。在治療滿12週之29名個案中,罹患其他精神疾病之情形仍以焦慮性疾患為主,治療滿12週後有20人(69%)之HDRS分數已達到緩解之程度且自殺意念明顯獲得改善。其神經心理測驗在短期記憶及執行功能表現皆呈現明顯進步,生活品質量表也顯著改善。在生化檢查部分,除了在服藥滿12週後在LDLC(低密度膽固醇)及TCHO(總膽固醇)有增加現象外,其他免疫與生化數值並無明顯變化。從服藥滿4週及12週對抗憂鬱劑之反應結果可看出在治療滿4週之緩解組與反應組在治療前之某些神經心理測驗比未緩解組及未反應組來的好,但在治療滿12週後,不管是緩解組與未緩解組或反應組與未反應組,在服藥前、後其神經心理測驗各分項測驗皆無顯著差異。本研究僅收到3名早發型老年憂鬱症患者,但仍可看出服藥滿12週時,早發型老年憂鬱症組之HDRS分數較高。在29名個案治療後其療效影響因素之單變項邏輯迴歸分析方面,發現服藥前HDRS分數越高,其服藥滿4週病情緩解的發生比相對減少,但服藥前HDRS分數不影響服藥滿12週病情緩解的發生比。此分析也發現沒罹患其他精神疾病者在第12週病情緩解的發生比顯著地增加。在主要照顧者之生活品質及負擔方面,僅收到19名前後同一位主要照顧者,發現主要照顧者於個案服藥前與服藥滿12週後及比較緩解組與未緩解組之主要照顧者於個案接受治療滿12週後,其照顧者負擔(CBI)及生活品質(QOL)方面均未達統計上之顯著差異。 本研究雖只有29人完成12週之治療,但仍能再次強調積極治療老年憂鬱症之重要,在治療滿12週後不僅症狀明顯改善,生活品質也跟著獲得改善,自殺意念也大大降低。尤其是病情比較嚴重者須要耐心的與醫師配合,雖然前4週之反應不佳,但滿12週後其治療反應會明顯改善。而本研究之結果正可以用來說明積極治療老年憂鬱症之成效,對目前國內憂鬱症及自殺之防治工作應有所助益。

English Abstract

With the rapid increase of elderly population in Taiwan, geriatric depression has become a focus in geriatric psychiatry and public health. This study is an observational study, and the objectives of this study were to evaluate the therapeutic effects of patients with geriatric depression receiving antidepressant for 12 weeks, and to detect the related factors of treatment response and remission. Subjects in our study were enrolled from the clinics of Chang Shan Medical University Hospital and Taichung Veteran General Hospital, who were older than 65 years old and diagnosed as major depression according to DSM-IV. Dementia was excluded by Mini-Mental State Examination (MMSE). Subjects received the antidepressant, sertraline, for 12 weeks. The tools we used included Mini-Mental State Examination (MMSE), Hamilton Depression Rating Scale (HDRS), MINI International Neuropsychiatric Interview, Caregiver Burden Inventory and WHOQOL-BRED. The brain image of MRI was arranged before the treatment, whereas the immune markers, inflammatory proteins and neuropsychological test were evaluated before treatment and 12 weeks after treatment. Data were analyzed by non-parametric tests due to a few cases. The differences in different kind of geriatric depression, such as remission and non-remission, response and non-response, early-onset and late-onset depression were compared. Thirty seven subjects were enrolled, but only 29 subjects completed the 12-week treatment. Anxiety disorders are the most common comorbid psychiatric illness in the 29 subjects. Sixty nine percent (20/29) of subjects achieved remission after taking antidepressant for 12 weeks and suicide idea was also significantly improved after 12-week treatment. Short-term memory, executive function and quality of life significantly improved after 12-week treatment. In the biochemistry tests, only low density lipoprotein cholesterol (LDLC) level and total cholesterol (TCHO) level were significantly increased after 12-week treatment. Before treatment, 1-month responders and 1-month remitters got better scores in some items of neuropsychological test compared to their counterparts respectively. However, before and after 12-week treatment, there was no difference in the neuropsychological test in the responders and remitters compared to their counterparts. Only 3 early-onset geriatric depressive subjects were enrolled. Compared with the late-onset geriatric depressive subjects, these 3 early-onset subjects had significantly higher HDRS scores after 12-week treatment. Simple logistic regression was used to analyze the possible variables which were related to remission or response. The results showed the subjects with high baseline HDRS score would have significantly lower remission rate after 4-week treatment. However, the baseline HDRS score did not affect the remission rate after 12-week treatment. The results also showed the elderly depressive patients without other psychiatric diagnosis would have better remission in the 12-week treatment. The caregivers’ burden and quality of life did not have any significant change after 12-week treatment for the depressive subjects. Results of this study re-emphasize the importance of aggressive treatment for geriatric depression, although only 29 subjects completed 12-week treatment in this study. After 12-week treatment, not only the depressive symptoms and suicide idea significantly improved, but also the life quality improved. Especially for the worse depressive elders, the treatment response may be not significant after 4-week treatment, however, they finally got good response after 12-week treatment. Results of this study may provide good information for the treatment response of geriatric depression and suicide prevention program in Taiwan.

Topic Category 醫藥衛生 > 醫藥總論
醫學院 > 醫學研究所
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