| Abstract: | 隨著台灣地區人口結構的化﹐憂鬱症已成為醫學重要的課題。國內對憂鬱症這方面的研究至今仍極為缺乏﹐因此解國人患同時期發作之憂鬱症之床病程﹐以提出治及預防對策遂變得刻容緩。根據發病紀的同﹐可分為早發型（ 60 歲以前發病）及晚發型（60 歲以後發病） 種。二者之症似﹐但晚發型憂鬱症較慢性化及再發﹔二者致病原因可能同﹐很多證據顯示腦血管病變可能會引起晚發型憂鬱症﹐因此提出 「血管性憂鬱」之學。 本研究的目的是要探討台灣早發型及晚發型憂鬱症患者之床表徵及對抗憂鬱劑（ Sertraline）之效。本研究是以中山醫學大學附設醫院科門診或住院的病患為研究對象﹐診斷符合 DSM-IV 重鬱症的診斷準則並排除痴呆症之病患﹐給予相同的抗憂鬱劑（ Sertraline）持續治一﹐比較組病人之基本資病程變化發情形治反應認知功能同時患之身體及疾病 MRI 之 vascular lesion 與各因子之間的關等。測驗工具包括﹕基本資Mini-mental Status Examination Hamilton Depression Rating Scale 及 MINI International Neuropsychiatric Interview。 完成三個月追蹤之本研究個案共計 16 名（早發型憂鬱症患者 2 名）﹐研究結果顯示組在一般人口學資上無顯著差。組在服藥滿三個月時﹐晚發組有 78.6﹪病情已緩解﹐而早發組的個案皆未達緩解的標準。組在治前後的認知功能上無差。僅有少個案合併有其他疾病。 本研究之限制在於由於只追蹤一﹐所以完成三個月追蹤之個案僅 16 名﹐且早發型憂鬱症之個案也僅 2 名﹐希望能持續追蹤舊個案並尋找新個案﹐以解台灣地區憂鬱症患者之情形。
Geriatric depression has become an important focus in geriatric psychiatry. However, geriatric depression was under-diagnosed and under-treated in the past. The consequences of geriatric depression are not only increasing patient's distress, but also increasing the cost of medical care, enhancing the disability of medical diseases, leading to cognitive impairment, increasing suicide rate or the mortality rate of medical diseases. We may divide geriatric depression into two subtypes according to the age of onset, i.e., early-onset type with the first episode occurred before 60 years old, and late-onset type with the first episode after or at 60 years old. Many depressive symptoms of these two types are similar, but it seems that late-onset geriatric depression tends to be chronic and has more relapses. Besides, there may be different causes exist for these two types of geriatric depression. More and more evidences were found to support the hypothesis of "vascular depression", which means that cerebrovascular lesions can lead to late life depression, especially the late-onset geriatric depression. The goals of our research are to compare the differences between early- and late-onset geriatric depression in the demographic data, clinical features, family history of psychiatric illness, life events, cognitive function, cerebrovascular lesion in MRI and drug response to antidepressant-sertraline. Study subjects are continuously enrolled from psychiatric clinics and acute psychiatric ward in Chung Shan Medical University Hospital. Subjects are 65 years old or older than 65 years, who meet the diagnostic criteria of major depressive episode in DSM-IV and dementia is excluded according to the diagnostic criteria of dementia in DSM-IV. Well-trained research assistant evaluates Mini-mental Status Examination (MMSE), Hamilton Depression Rating Scale (HAM-D) in the day before treatment, the 2nd weeks, 4th week and 3rd month and senior psychiatrists do the MINI International Neuropsychiatric Interview (MINI-PLUS) during the first visit. All subjects receive antidepressant (sertraline) and dosage is adjusted according to their clinical symptoms. T-test or Chi-Square tests is done to analyze the differences between early-onset and late-onset geriatric depressive subjects. Totally, 16 subjects complete 3-month medication study. There are only 2 cases with early-onset geriatric depression. No significant difference was noted between both groups in terms of demographic data, MMSE (before and after medication), response and remission rate, psychiatric comorbidity. The limitation of this study is short-term follow-up and only have few cases. We need to have long-term follow-up to get the real phenomenon of geriatric depression in Taiwan. |
