传统意义上，抗抑郁药物的效果要在几周之后显现，但有些研究显示，抗抑郁药物治疗2周内即存在早期药物应答，而且这种早期初始应答可能预测最终的治疗结局。

        荷兰学者们近期开展了一项事后分析研究，旨在住院严重抑郁患者人群中探讨丙咪嗪或文拉法辛治疗过程中早期改善的预测价值。研究者们对两个几乎相同的试验数据汇集后进行事后分析。纳入149例根据DSM-IV诊断为严重抑郁的患者，基线17项汉密尔顿抑郁量表(HAM-D)分数≥17。患者被随机双盲分为两种抑郁药治疗。评估2周后早期改善情况(HAM-D评分降低≥25 %)，以及6周急性治疗后的治疗应答情况(HAM-D评分降低≥50 % )。

        结果显示，64例患者达到早期改善，38例(59%)成为应答者;85例未达到早期改善，仅23例(27%)成为应答者。达到早期改善者和未达到早期改善者之间的至应答时间存在显著差异。早期改善对最终应答的敏感性预测为中度。

        该研究表明，虽然早期改善的敏感性为中度，基于临床症状的严重度，医生在治疗严重抑郁患者时可能会在较早期阶段审慎考虑调整治疗方案。

        相关论文近期发表于《精神药理学》(Psychopharmacology.)杂志。

        参考文献：Michelle C. Odden,et al.Published online: 23 October 2014.Psychopharmacology (2015) 232:1347–1356.DOI 10.1007/s00213-014-3765-1

Early improvement as a predictor of eventual antidepressant treatment response in severely depressed inpatients
Marlijn Vermeiden & Astrid M. Kamperman & Monique E. Vulink &
Walter W. van den Broek & Tom K. Birkenhäger

Abstract
Rationale Traditionally, the therapeutic effect of antidepressants is thought to take several weeks. However, several
studies found evidence of early drug response occurring within the first 2 weeks of antidepressant treatment and that this early onset response may predict eventual treatment outcome.
Objective This study aims to investigate the predictive value of early improvement in the course of treatment with imipramine or venlafaxine in an inpatient population with severe major depression.
Method A post hoc analysis was conducted after pooling data from two almost identical trials. The study included 149 patients with DSM-IV diagnosis major depression and a baseline score ≥17 on the 17-item Hamilton Rating Scale for Depression (HAM-D). Patients were randomized for doubleblind treatment with either antidepressant. Early improvement (≥25 % reduction on HAM-D score) was evaluated after 2 weeks and response (≥50 % reduction on HAM-D score) after 6 weeks of acute treatment.
Results Of 64 patients achieving early improvement, 38(59 %) became responders, whereas of 85 patients not achieving early improvement, only 23 (27 %) became responders.There was a significant difference in time to response between patients achieving early improvement and patients not achieving early improvement. Early improvement is a modest sensitive predictor for eventual response.

Conclusion In the present study, although the sensitivity of early improvement was modest, based on the severity of
clinical symptoms, a clinician treating a patient with severe major depression may seriously consider changing the treatment at an earlier stage than is presently customary.