首发老年抑郁症的临床特点研究

Clinical features of first-onset elderly depression

目的比较首发老年抑郁症和首发中青年抑郁症患者在发病的临床表现和治疗效果等临床特点的差异。方法选取符合入组标准的首发老年抑郁症患者60例作为研究对象，同时按照性别、文化程度等选取60例首发中青年抑郁症患者作为对照，通过自制调查问卷获取患者的发病诱因及相关资料，两组患者均服用5-羟色胺再摄取抑制剂（SSRIS）抗抑郁剂治疗8周，采用汉密尔顿抑郁量表（HAMD24）和汉密尔顿焦虑量表（HAMA）评定两组患者的临床症状，并在治疗后1，2，4，8周分别再对两组患者进行HAMD评定，通过计算HAMD减分率来评定治疗效果。结果首发老年抑郁患者最常见的首发症状为躯体症状，而对照组患者则为失眠。首发老年抑郁患者的HAMD总分、焦虑／躯体化得分显著高于对照组，而睡眠障碍、体质量减轻、日夜变化等得分显著低于对照组。HAMA评定首发老年抑郁患者HAMA总分和躯体因子分高于对照组。在为期8周的研究周期内，SSRIs对首发老年抑郁患者的治愈率为51．7％，对对照组的治愈率为91．7％，前者治愈率明显低于后者，其差异有统计学意义（P〈0．01）。结论首发老年抑郁患者最常见的首发症状为躯体症状，同时焦虑、疑病、记忆减退、躯体症状等症状的发生率高于中青年抑郁症患者，但晨重晚轻等生物学改变的发生率较中青年抑郁症患者少见，对SSRIs类抗抑郁剂的治疗效果不如中青年抑郁症患者好。

Objective To investigate the clinical features of the first-onset depression in elderly patients by comparing the clinical manifestations and treatment outcomes in the young patients. Methods Sixty elderly patients with first-onset depression who met the CCMD-3 criteria in our department from January to December 2010 were enrolled in the study. Sixty sex and education-level matched young patients with first-onset depression were selected as controlled subjects. A self-made questionnaire was used to analyze the triggers of depression and collect the related data. Selective serotonin reuptake inhabitors （SSRIs） were used to treat depression in both groups for 8 weeks. Hamilton Depression Rating Scale （HAMD） and Hamilton Anxiety Scale （HAMA） were employed to evaluate the depressive and related symptoms in 1, 2, 4, and 8 weeks after the treatment. Results The most common initial symptom was physical complaints in the elderly with first-onset depression. The HAMD total score, anxiety/somatization scores in the elderly were significantly higher than those in younger patients. But the scores of sleep disorders, weight loss and diurnal variation was lower in these elderly than in the control group. HAMA total score and body factors were significantly higher in the elderly patients than the control group. After 8 weeks treatment of SSRIs, the cure rate was 51.7% for the elderly patients, which was significantly lower than that of the control group （91.7%, P 〈 0.01）. Conclusion The most common initial symptoms of the elderly depression are physical complaints. Symptoms such as anxiety, hypochondria, memory loss and physical complaints are more common in the elderly than in the young. But the biological symptoms, such as heavy body weight at morning and light at night are less common in the elderly. The efficacy of SSRIs in the elderly is not as good as for the young depression.