阿戈美拉汀治疗抑郁障碍患者快感缺失的疗效研究

Efficacy of agomelatin in the treatment of anhedonia in patients with depressive disorders

目的评价阿戈美拉汀治疗抑郁障碍患者快感缺失的疗效。方法本研究共纳入58例抑郁障碍患者,所有受试者接受阿戈美拉汀(25~50 mg/d,可变剂量)治疗8周。采用Snaith汉密尔顿快感缺失量表(SHAPS)、蒙哥马利抑郁评定量表(MADRS)评估患者抑郁及快感缺失的情况,采用Sheehan残疾量表(SDS)和世界卫生组织的5项健康指数(WHO-5)量表评估患者功能损害和生活质量。结果(1)阿戈美拉汀治疗8周后,SHAPS终点的临床应答和缓解率分别为64.71%(33/51)和58.82%(30/51),SHAPS和MADRS快感缺失因子分较基线显著改善(P<0.01)。(2)回归分析显示,性别、首发年龄和精神疾病家族史影响患者快感缺失的缓解。(3)治疗8周末,SHAPS和MADRS快感缺失因子分较基线的改善,与WHO-5和SDS评分较基线的改善显著相关(P<0.01)。(4)中介分析显示,快感缺失的改善可调节抑郁症状严重程度和社会功能改善之间的关联。结论阿戈美拉汀对抑郁症快感缺失疗效显著,且快感缺失的改善是抑郁症状与社会功能改善之间强有力的中介。

Objective To evaluate the effectiveness of agomelatine in the treatment of anhedonia in patients with depressive disorders. Methods A total of 58 subjects were included in the study. All patients were treated with agomelatin( 25-50 mg/d, variable doses) for 8 weeks. Snaith-Hamilton Pleasure Scale( SHAPS) and Montgomery-?sberg Depression Rating Scale( MADRS) were used to evaluate patients' depression and anhedonia, and the Sheehan Disability Scale( SDS) and the 5-Item World Health Organization Well-Being Index (WHO-5) were used to evaluate patients' functional impairment and quality of life. Results (1)After 8 weeks of treatment with agomelatin, the clinical response and remission rates of SHAPS were 64.71%(33/51) and 58.82%(30/51). The SHAPS and MADRS anhedonia factors after the treatment were significantly improved compared to baseline( P < 0.01).( 2)Regression analysis showed that gender, first-episode age and family history of mental illness affected the improvement of anhedonia.( 3)At the end of 8 weeks of treatment, the improvement of SHAPS and MADRS anhedonia factor was significantly correlated with the improvement of WHO-5 and SDS scores( P<0.01).( 4)Mediational effect analysis showed that the improvement in anhedonia mediated the relationship between depressive severity and the improvement of social functions. Conclusions Agomelatin has a significant effect on anhedonia in patients with depressive disorder, and the improvement of anhedonia is a powerful mediator for the relationship between depressive symptoms and the improvement of social functions.