艾司西酞普兰治疗难治性抑郁症的临床研究

目的了解艾司西酞普兰治疗难治性抑郁症的疗效和安全性。方法给符合入组标准的患者口服艾司西酞普兰,于治疗前及治疗后第2、4、6、8周末使用汉密尔顿抑郁量表（HAMD）和不良反应量表（TESS）进行评分,依据量表评分判定临床疗效和不良反应。结果治疗第2周时,HAMD总分开始明显下降,与治疗前相比有显著性差异（t=8.88,P〈0.01）,治疗8周后总有效率55.26%。不良反应最常见的是食欲下降5例（13.16%）,其次恶心3例（7.89%）,但不影响正常治疗。结论艾司西酞普兰治疗难治性抑郁症有效、安全。     

舒肝解郁胶囊与艾司西酞普兰治疗老年抑郁症合并躯体疾病患者的对照分析

目的:探讨舒肝解郁胶囊与艾司西酞普兰治疗合并躯体疾病老年抑郁症患者的疗效和不良反应。方法:本文将70例合并躯体疾病的老年抑郁症患者随机分为舒肝解郁胶囊组和艾司西酞普兰组,分别在治疗前和治疗后第1、2、4、8周末分别以汉密尔顿抑郁量表(HAMD)评价疗效,以副反应量表(TESS)评定不良反应。结果:舒肝解郁胶囊和艾司西酞普兰均具有良好的抗抑郁作用,疗效相当。两组间的不良反应均轻微且无显著性差异。结论:舒肝解郁胶囊能有效治疗合并躯体疾病的老年抑郁症患者,且安全,依从性好。     

艾司西酞普兰与氟西汀治疗老年抑郁症对照研究

目的:评价艾司西酞普兰治疗老年抑郁症的疗效与安全性。方法:将68例老年抑郁症患者随机分为两组,每组34例,研究组口服艾司西酞普兰治疗,对照组口服氟西汀治疗,观察6周。于治疗前及治疗第2、4、6周末采用汉密顿抑郁量表评定临床疗效。副反应量表评定不良反应。结果:治疗后两组汉密顿抑郁量表评分均较治疗前显著下降(P<0.01);研究组治疗2周末较对照组下降更显著(P<0.05)。治疗6周末,研究组有效率81.3%,对照组为78.1%,两组差异无显著性(P>0.05);两组不良反应均轻微,主要表现为恶心、呕吐等消化系统症状,发生率差异无显著性(P>0.05)。结论:艾司西酞普兰治疗老年抑郁症疗效显著,与氟西汀相当,安全性高,但艾司西酞普兰起效更快。     

艾司西酞普兰合用低剂量舒必利治疗抑郁症临床观察

目的:探讨艾司西酞普兰联合低剂量舒必利治疗抑郁症的疗效与不良反应。方法:将52例抑郁症患者随机分为合用组(艾司西酞普兰联合小剂量舒必利)和单用组(单用艾司西酞普兰)各26例,疗程6周。采用汉密尔顿抑郁量表(HAMD)及治疗中出现的症状量表(TESS)评定疗效与不良反应。结果:两组HAMD评分治疗后均显著下降(P<0.01),以合用组更明显;两组不良反应差异无统计学意义(P>0.05)。结论:艾司西酞普兰联合低剂量舒必利治疗抑郁症疗效好,起效快,且不良反应轻微。     

艾司西酞普兰治疗老年抑郁症疗效观察

目的观察艾司西酞普兰治疗老年抑郁症的疗效。方法将60例老年抑郁症患者随机分为研究组和对照组各30例。研究组予以艾司西酞普兰口服治疗,对照组予以文拉法辛口服治疗,观察6周。于治疗前及治疗后第1、2、4、6周末采用汉密尔顿抑郁量表(HAMD)评定临床疗效,采用不良反应量表(TESS)评定不良反应。结果研究组治疗后第6周末总有效率为90.00%,对照组为83.33%,差异无统计学意义(P>0.05)。2组治疗后第1周末始HAMD评分低于治疗前,且研究组低于对照组,差异均有统计学意义(P<0.05和P<0.01)。但2组治疗后第2、4、6周末HAMD评分比较差异均无统计学意义(P>0.05)。2组不良反应均轻微。结论艾司西酞普兰治疗老年抑郁症的疗效与文拉法辛相当,且起效较文拉法辛快,安全性高,依从性好。     

Depression-like and anxiety-like behavioural aftermaths of impact accelerated traumatic brain injury in rats: A model of comorbid depression and anxiety?

Depression and anxiety tend to be the most prevalent conditions among the multitude of neurobehavioural disorders which cause distress in the survivors of traumatic brain injury (TBI). The objective of the present investigation was to examine depression-like and anxiety-like behaviour of rats following diffuse TBI. Impact accelerated TBI was induced in anaesthetised rats by a modified weight drop method. TBI and sham-operated rats received either a chronic (14 days) regimen of escitalopram (5–20 mg/kg) or vehicle, following which they were subjected to a behavioural test battery. The results evince the depression-like behaviour of TBI rats in modified open field exploration, hyperemotionality, socio-sexual interaction and elevated plus-maze exploration paradigms. In addition, an anxiety-like behaviour was evident in social interaction and marble-burying tests. Chronic escitalopram (10 and 20 mg/kg) treatment significantly attenuated the TBI associated behavioural deficits. In conclusion, the aforesaid behavioural anomalies observed in TBI rats are analogous to comorbid anxiety and depression in humans. These findings substantiate the TBI rats as a candidate model of comorbid anxiety and depression.     

A Case of Galactorrhea Associated with Excitalopram

Escitalopram is one of the most popular selective serotonin reuptake inhibitors (SSRIs) in current use as a first-line treatment for depression. Escitalopram is well-tolerated and rarely associated with serious side effects. Endocrine and reproductive side effects of serotonergic antidepressants are uncommon and galactorrhea is very rarely mentioned among SSRI-related side effects. Serotonin-enhancing antidepressants may result in a rise in prolactin levels through suppression of dopamine neurotransmission. In the present study, we report a case of hyperprolactinemic galactorrhea associated with escitalopram. A 36-year-old woman developed galactorrhea after initiation of escitalopram for depression and was found to have an elevated prolactin level. Escitalopram was discontinued with resolution of the patient''s galactorrhea and normalization of her prolactin level.     

艾司西酞普兰和氟西汀治疗首发抑郁症临床疗效及认知功能影响的比较

目的 比较艾司西酞普兰和氟西汀对抑郁症治疗的临床疗效及对抑郁症患者认知功能的影响.方法 将60例抑郁症患者随机分为艾司西酞普兰组(30例)和氟西汀组(30例),进行临床对照试验,两组药物治疗量分别为10～20 mg/d,20～40 mg/d,疗程8周.采用汉密尔顿抑郁量表17项(HAMD17)、临床整体量表-疗效总评估量表(CGI-SI)为疗效指标,以词汇流畅性测验和威斯康星卡片分类测验(WCST)评定患者认知功能,不良反应症状量表(TESS)为不良反应指标.结果 第1周艾司西酞普兰组有效率为20.00% 显著高于氟西汀组有效率(3.33%)(χ2=4.04,P <0.05).第8周治疗结束时艾司西酞普兰组有效率为73.33%,氟西汀组有效率为70.00%,两组疗效差异无统计学意义(χ2=0.08,P >0.05);在治疗第8周时与基线评分相比,两组在词汇流畅性测验和WCST的总测验次数、持续错误数和随机错误数中的评分均有改善,差异具有显著性( t =1.70～6.00, P <0.05),在WCST的正确数和分类数的评分改善不明显,差异无统计学意义( t =0.29～0.66, 均P >0.05).两组之间在词汇流畅性测验和WCST各项改善间的比较,差异无统计学意义( t =0.02～0.49,均P >0.05);两组与药物相关的不良反应出现频率的差异无统计学意义(χ2=0.07,P >0.05).结论 艾司西酞普兰和氟西汀治疗抑郁症疗效相当,均能部分缓解抑郁伴发的认知功能障碍,且副作用较小、安全性好,但艾司西酞普兰起效更快,有利于迅速缓解患者症状.     

Efficacy and tolerability of escitalopram in anxiety disorders: a review

INTRODUCTION: Anxiety disorders are highly prevalent and disabling disorders, for which selective serotonin reuptake inhibitor (SSRI) antidepressants are an effective treatment. Escitalopram is the most selective SSRI available. Beyond its well-established efficacy in depression with or without anxiety, preclinical studies have demonstrated that escitalopram has a broad spectrum of anxiolytic activity. AIM OF THE REVIEW: This review focuses on the therapeutic use and the tolerability issues of escitalopram in the treatment of adult patients with panic disorder, generalized anxiety disorder (GAD), social anxiety disorder, and obsessive-compulsive disorder (OCD), on the basis of numerous recent short-term and long-term controlled studies in these disorders. In a 10-week randomised, double-blind trial in patients with panic disorder, escitalopram (flexible doses 5-10 mg/d) was significantly more effective than placebo in reducing the panic attack frequency, with a faster onset of action than citalopram. Fifty percent of escitalopram recipients and 38% of placebo recipients experienced no panic attacks, with a similar incidence of the most common adverse events for both groups. LITERATURE FINDINGS IN PD: In an open-label study in elderly (>65 years) patients with panic disorder, improvement in panic attack frequency and secondary efficacy variables occurred more rapidly in escitalopram than citalopram recipients. LITERATURE FINDINGS IN GAD: In four double-blind, comparative, eight- to 12-week studies in patients with GAD, escitalopram was more effective than placebo and at least as effective as paroxetine in reducing the mean Hamilton Rating Scale for Anxiety total score. Escitalopram 10-20 mg/d demonstrated continued efficacy in a 24-week extension study of short double-blind trials and in a placebo-controlled, double-blind, 24/76-week relapse-prevention study. In this trial, escitalopram recipients showed a significantly longer time to relapse and reduced risk of relapse than placebo recipients, and the risk of relapse was 4.04 times higher in the placebo group than in the escitalopram group. Escitalopram was well tolerated and only 7% patients withdrew, due to adverse events in the escitalopram group, versus 8% in the placebo group. LITERATURE FINDINGS IN SOCIAL PHOBIA: In two randomised, double-blind, 12- and 24-week studies in patients with social anxiety disorder (social phobia), escitalopram 10-20 mg/d was generally more effective than placebo and at least as effective as paroxetine in reducing the mean Liebowitz Social Anxiety Scale total scores. In a 24-week double-blind, placebo-controlled relapse-prevention study, escitalopram recipients had a longer time to relapse and reduced risk of relapse compared with placebo recipients, and significantly fewer escitalopram than placebo recipients relapsed (22% versus 50%). In these studies, the treatment effects of escitalopram were independent of gender, symptom severity and chronicity, and comorbid depressive symptoms, and the drug was tolerated well. LITERATURE FINDINGS IN OCD: Finally, in patients with OCD, escitalopram 20mg/d for 12 weeks was more effective than placebo, and at least as effective as paroxetine 40 mg/day, with respect to a mean reduction from baseline in the Yale-Brown Obsessive Scale total score. In a 24-week, randomised, placebo-controlled relapse-prevention study, the proportion of patients who relapsed in the escitalopram group (23%) was 2.74 times lower than in the placebo group (52%). In both groups, the majority of adverse events reported were mild to moderate. CONCLUSION: On the whole, numerous clinical data indicate that escitalopram, 10-20 mg/d, is an effective and well-tolerated first-line treatment option for the management of panic disorder, GAD, social anxiety and OCD. Beyond short-term demonstrations of efficacy in these disorders, several controlled relapse-prevention studies showed the necessity and utility of maintaining the treatment six months or more after the remission has been obtained.