輕微憂鬱未加治療會持續且隨著時間惡化
作者：Caroline Cassels
出處：WebMD醫學新聞
February 11, 2010 — 新研究認為，輕微憂鬱未加治療並不會隨著時間緩解，反而有不少病患會持續且惡化，最後導致重度憂鬱症診斷。
紐約哥倫比亞大學醫學中心研究者進行的研究顯示，在研究開始前一年時，篩檢為輕微憂鬱症狀的一線照護病患、且未接受任何心智健康治療者，有62%在4年追蹤期間內符合重度憂鬱診斷。
Myrna M. Weissman博士等研究者寫道，我們的發現認為，簡單的篩檢步驟、特別是用於重度憂鬱的，可以辨識症狀較輕微，但是持續有心智健康問題的一線照護病患。
這項研究登載於2月的Psychiatric Services期刊。
研究者指出，雖然在一些一般醫療環境中支持精神異常的篩檢，但是其價值受到批評。根據研究者表示，比較未發現憂鬱症者以及確認憂鬱之病患的跨世代短期追蹤研究認為，未發現的憂鬱症傾向是較輕微的，通常無須介入即可緩解。
不過，他們指出，需要對未治療之輕微憂鬱症狀病患的長期後果有更好的瞭解。
為了確認篩檢對於此類病患的臨床效用，以及探討長期的結果，研究者對於一般精神異常篩檢為陽性、但一開始沒有接受治療之病患進行了一個長期追蹤。
該世代包括了34名低收入、成年、篩檢為輕度憂鬱、躁鬱症、焦慮、物質濫用異常的一線照護病患，然後，在平均3.7年之後，由對第一次篩檢不知情的醫師再度進行評估。這些研究對象在第一次篩檢之前都沒有接受過精神科照護。
研究顯示，開始時有39人有憂鬱症狀，其中的62%在追蹤時發生重度憂鬱異常。
其他指標也指出，這些病患傾向有比較不好的進展，當研究者在追蹤訪談中測量社會功能時，他們發現，開始時有憂鬱症狀的病患顯然比開始時為陰性者惡化。
例如，篩檢為陽性的病患，在追蹤訪談前一年精神科急診一次以上的風險達6倍以上，研究者進行的附加分析顯示，開始時篩檢為陽性，可以預測在追蹤時的酒精或藥物使用異常，以及病患的心理健康狀態不佳或相當情緒化。
Weissman博士在聲明中指出，這些發現是接著一月份媒體密切注意的研究報告之後，當時顯示輕微症狀的憂鬱病患使用藥物的效果並沒有比安慰劑好，認為輕微症狀病患不需要治療。
當然，臨床試驗中的病患接受了相當程度的注意而未接受治療，我們的發現認為，輕微憂鬱而未治療病患的病程不佳。
國家心智健康研究中心、GlaxoSmithKline藥廠與Eli Lilly Company藥廠支持本研究。研究作者、Daniel J. Pilowsky醫師報告接受Astra Zeneca藥廠的發言費用，Mark Olfson醫師報告接受AstraZeneca、Bristol-Myers Squibb、Eli Lilly & Company、Janssen、McNeil Pharmaceuticals以及 Pfizer等藥廠之支持或擔任其顧問。其他研究作者皆宣告沒有相關財務關係。
Untreated Mild Depression Can Persist, Worsen Over Time
By Caroline Cassels
Medscape Medical News
February 11, 2010 — Left untreated, mild depression does not resolve with time and for a significant number of patients will persist and worsen, eventually resulting in a diagnosis of major depressive disorder, new research suggests.
A study conducted by investigators at Columbia University Medical Center, New York, showed that 62% of primary care patients who screened positive for mild depressive symptoms at baseline and who had not received any mental health treatment during the past year met criteria for major depression at 4-year follow-up.
"Our findings indicate that simple screening procedures, especially for major depression, can identify primary care patients with milder symptoms that are nevertheless persistent and enduring mental health problems," the study authors, led by Myrna M. Weissman, PhD, write.
The study is published in the February issue of Psychiatric Services.
The investigators note that although screening for psychiatric disorders has gained acceptance in some general medical settings, critics argue about its value. According to the study authors, cross-sectional and short-term follow-up studies comparing patients with undetected depression with those with identified depression suggest that undetected depression tends to be milder and often resolves without intervention.
However, they note that there is a need to better understand the long-term course of untreated patients with mild depressive symptoms.
To determine the clinical utility of screening and look at long-term outcomes in such patients, the researchers conducted a long-term follow-up of patients who screened positive for common psychiatric disorders but who were initially not in treatment.
The cohort included 348 low-income, adult, primary care patients who were screened for major depression, bipolar disorder, anxiety, and substance use disorders at baseline and then reassessed after a mean of 3.7 years by a clinician masked to the results of the initial screen. None of the subjects had received psychiatric care in the year before initial screening.
The study showed that of 39 individuals with depressive symptoms at baseline, 62% of them had major depressive disorder at follow-up.
Other indicators also pointed to a less than benign course for these patients. When researchers measured social functioning at the follow-up interview, they found that patients who had depressive symptoms at baseline had significantly worse function than their counterparts who screened negative at study outset.
For instance, patients who screened positive were more than 6 times as likely to report having made 1 or more visits to a psychiatric emergency department in the year before the follow-up interview. Additional analyses by the researchers showed that a positive baseline screen for depression predicted an alcohol or drug use disorder at follow-up and patients' report of poor or fair emotional or physical health.
"These findings come in the wake of intensive focus by the media on a study reported in January, which showed that depressed patients with mild symptoms did not do any better with medication than with placebo, suggesting that patients with mild depression don’t need treatment," Dr. Weissman said in a statement.
"Of course, patients in a clinical trial are receiving a considerable amount of attention and are not untreated. Our findings suggest that mildly depressed untreated patients do not have a benign course of illness."
The study was supported by the National Institute of Mental Health, GlaxoSmithKline, and Eli Lilly Company. Study author Daniel J. Pilowsky, MD, MPH, reports receiving speaker fees from Astra Zeneca. Mark Olfson, MD, MPH, reports he has received support from or has served as a consultant for AstraZeneca, Bristol-Myers Squibb, Eli Lilly & Company, Janssen, McNeil Pharmaceuticals, and Pfizer. The other study authors have disclosed no relevant financial relationships.
