Emine AK, Melike Ceyhan ŞENGÜL BALCI, Süheyla BULUT DOĞAN, Sedar BULUT

Major Depresyonda Antidepresan Tedaviye Erken Cevabın Tedavi Yanıtını Yordayıcılığı

Amaç: Depresif bozukluğu olan olgularda, başlanan antidepresan tedaviye cevabın nasıl olacağı öngörülebilirmi? Günümüzde antidepresan tedavide etkinliğin ortayaçıkması için beklenmesi gereken ve genel görüş halinegelen 6 haftalık sürenin kısaltılması tedavi müdahalelerinin daha erken yapılabilmesi açısından önemli olabilir. Buçalışmada depresyonda antidepresan tedavi ile belirtilerdeerken dönemdeki azalmanın tedavi yanıtına olan etkisininaraştırılması amaçlanmıştır. Yöntem: Çalışmaya DSM-IV ölçütlerine göre majör depresifbozukluk tanısı alan, ayaktan ya da yatarak antidepresantedavi başlanan 87 olgu alınmıştır. Tedavinin başlangıç, 2.,4. ve 6. haftalarında Hamilton depresyon ölçeği (HAM-D)uygulanmış; altıncı haftada HAM-D puanlarında %50 vedaha fazla azalma tedaviye yanıt olarak belirlenmiştir. HAM-D puanlarında 2. ve 4. haftalardaki azalmanınderecesi ile 6. haftadaki yanıt oranları arasındaki ilişkiincelenmiştir. Bulgular: Altıncı haftanın sonunda 87 depresyon olgusunun 73ü (%83.9) tedaviye yanıt vermiş, 14ü (%16.1)yanıt vermemiştir. İkinci hafta HAM-D puanlarındaki azalmanın derecesi ile 6. haftadaki yanıt oranları arasında istatistiksel olarak anlamlı fark bulunmamıştır. Dördüncü haftaHAM-D puanlarındaki azalmanın derecesi ile 6. haftadakiyanıt oranları arasında istatistiksel olarak anlamlı bir farkbulunmuştur (p=0.003). Tartışma: Çalışmamızda tedavinin erken dönemlerindebelirtilerinde iyileşme olmayan olguların, süreçte de tedaviyanıtlarının iyi olmadığı tespit edilmiştir. Elde edilen verilerdoz artırımı ya da ilaç değişikliklerinin hastalığın dahaerken dönemlerinden itibaren gündeme getirilebileceğinigöstermesi bakımından önemlidir.

Value of early symptomatic response to antidepressant treatment in predicting treatment response in major depression

Objective: Is it possible to predict the antidepressanttreatment response in patients with major depressivedisorder? For the antidepressant treatment, the commonbelief is to wait 6 weeks for deciding its effectiveness.It seem to be crucial to shorten this period for thepatients with depressive symptoms in order to makeearlier interventions. The aim of this survey is to find theassociation between early symptomatic improvementand the clinical response to antidepressant treatment indepression. Method: Eighty-seven participants who met the DSM-IVcriteria for major depressive disorder in both inpatient andoutpatient clinics were included in this study. During theinitial, second, fourth and sixth weeks of the treatmentHamilton Depression Scale (HDS) were applied; the %50reduction of the HDS score achieved in the sixth week wasdefined as treatment response. The relation between thedegree of decrease in second and fourth week HDS scoreswith the response in the sixth week were investigated. Results: At the end of sixth week, 73 (%83.9) of87 patients responded to their treatment, whereas 14(%16.1) of them did not. The correlation between thedegree of reductions in HDS scores at the second andsixth weeks was not statistically significant, whereasstatistically significant results were found between thedecreases in HDS scores at fourth and sixth weeks. Discussion: The findings of this study suggest that thepatients who did not respond to their treatment in theearly stage did not show satisfactory response to theirtreatment afterwards. Based on the results, increasing thedoses and switching the drugs may well be consideredeven in the early stages of the disorder.

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