目的:抑郁症的治疗反应是一个重大挑战,因为超过三分之一的患者在两次尝试抗抑郁治疗后没有缓解,并且会出现治疗抵抗的抑郁症。为了更好地适应治疗耐药患者的治疗策略,仍需要确定治疗反应的预测指标和标志物。并行,抑郁症患者表现出认知功能障碍。这项研究旨在描述和比较认知表现,包括在6个月时将成为反应者的治疗抗性抑郁症患者与非反应者。并评估认知指标对治疗改变后6个月临床治疗反应的预测价值。
方法:观察性研究。患者在临床(HDRS和BDI-II)和认知水平使用标准化工具评估记忆,执行功能,注意,和社会认知,在抗抑郁治疗改变之前。纳入后六个月,根据是否存在治疗反应,将其重新评估并分为两组,定义为HDRS和BDI-II提高50%。然后比较纳入时收集的认知得分。此外,采用单因素logistic回归模型。
结果:本研究纳入了30例患者。只有13个月可以评估6个月。在这些患者中,4人对新疗法有反应,9人无应答.与评估执行功能和注意力的测试规范相比,两组患者的认知表现都异常。统计分析未显示6个月时响应者和非响应者的认知表现之间的任何差异。回归分析显示认知评分与6个月时的治疗反应之间没有关联。
结论:执行功能在难治性抑郁症中起重要作用。为了提高对抑郁症亚型的认识和识别,认知指标应系统地纳入未来的研究。
OBJECTIVE: Therapeutic response in depression is a major challenge since more than one third of patients are not in remission after two attempts of antidepressant treatment and will present a treatment-resistant depression. In order to better adapt therapeutic strategies for treatment-resistant patients, predictive indicators and markers of therapeutic response still need to be identified. In parallel, patients with depression exhibit disturbances in cognitive functioning. This study aims to describe and compare cognitive performances collected at inclusion of patients presenting treatment-resistant depression who will be responders at 6 months to those of non-responders, and to evaluate the predictive value of cognitive indicators on clinical therapeutic response at 6 months after a therapeutic modification.
METHODS: Observational study. Patients were evaluated at the clinical (HDRS and BDI-II) and cognitive levels using standardized tools assessing memory, executive functions, attention, and social cognition, prior to a change in antidepressant treatment. Six months after inclusion, they were reassessed and classified into two groups based on the presence or absence of therapeutic response, defined by a 50% improvement on HDRS and BDI-II. The cognitive scores collected at inclusion were then compared. Additionally, univariate logistic regression models were used.
RESULTS: Thirty patients were included in this study. Only 13 could be evaluated at 6 months. Among these patients, four had responded to the new treatment while nine were non-responders. Both groups of patients presented deviant cognitive performances compared to norms on tests evaluating executive functions and attention. Statistical analyses did not reveal any difference between the cognitive performances of responders and non-responders at 6 months. Regression analyses showed no association between cognitive scores and therapeutic response at 6 months.
CONCLUSIONS: Executive functioning plays a significant role in treatment-resistant depression. In order to improve the understanding and identification of subtypes of depression, cognitive indicators should be systematically integrated into future research.