米氮平与氟西汀治疗抑郁症的临床疗效观察

目的：观察分析米氮平与氟西汀治疗抑郁症的临床疗效。方法2015年1月～2015年12月收治门诊及住院抑郁症患者85例。随机分成两组,对照患者采用氟西汀进行治疗,观察组患者采用米氮平进行治疗,两组患者接受治疗前后分别使用HAMD （17项）进行评分以及效果对比。结果接受治疗后,观察组患者的HAMD评分为（6．89±2．16）,对照组患者的HAMD评分为（11．17±4．46）,观察组患者汉密尔顿抑郁量表评分改善情况明显优于对照组（ t＝7．923,P＜0．05）。结论米氮平临床治疗抑郁症效果显著,副作用少,值得临床推广。     

Epidermolysis Bullosa Pruriginosa successfully treated with concomitant topical and systemic agents

Epidermolysis bullosa pruriginosa, a genetic mechanobullous disease, manifests at birth or late in life and is characterised by intense pruritus, resulting in lichenified or nodular prurigo-like lesions and scarring most prominent on the shins. Treatment is unsatisfactory. We report a patient treated with success using a combination of topical and systemic agents.     

丁螺环酮联合米氮平治疗老年期抑郁症的对照研究

目的观察丁螺环酮联合米氮平治疗老年期抑郁症的疗效和安全性。方法57例老年抑郁症患者分为2组,丁螺环酮联合米氮平治疗30例,为研究组,单用米氮平27例,为对照组。采用汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）和不良反应量表（TESS）分别观察疗效和不良反应,连续观察6周。结果 在治疗第1周,2组HAMD和HAMA评分均下降,但2组间有显著性差异（P〈0．01）。第2周末开始2组间HAMD和HAMA评分差异无显著性。第6周末2组显效率分别为83．3％和81．5％,差异无统计学意义（P〉0．05）。2组间TESS评分每周差异亦无统计学意义（P〉0．05）。结论 丁螺环酮联合米氮平治疗老年期抑郁症起效更快,病人的满意度和依从性更好。     

逍遥散合六味地黄丸加减配合米氮平治疗广泛性焦虑症60例

[目的]观察逍遥散合六味地黄丸加减配合米氮平治疗广泛性焦虑症疗效。[方法]对60例广泛性焦虑症采用逍遥散合六味地黄丸加减配合米氮平治疗。治疗30d判定疗效。[结果]临床治愈26例,有效30例,无效4例,总有效率93.33%。[结论]逍遥散合六味地黄丸加减配合米氮平治疗广泛性焦虑症疗效满意,副作用少。     

Mirtazapine for the treatment of hot flushes in breast cancer survivors: a prospective pilot trial

The purposes of the study are to evaluate the efficacy and safety of mirtazapine 30 mg/daily for 12 weeks to reduce hot flushes (HF) in women with previous breast cancer and to assess the influence of the same treatment on sleep quality and other menopausal symptoms. A prospective pilot trial was conducted in 40 breast cancer patients with at least seven HF per day. A HF diary was completed daily; sleep quality and other menopausal symptoms were assessed with the Pittsburgh Sleep Quality Index (PSQI), the Menopause Rating Scale (MRS) and the SF-36 Health Survey. Treatment was never started by 13 out of 40 patients (32.5%) and was interrupted by 7 out of 27 patients (25%) due to of the occurrence of side effects (mostly somnolence). In the remaining 20 patients who completed the three months treatment period, there was a 55.6% (p < 0.05) reduction in HF frequency and 61.9% (p < 0.05) reduction in HF score as compared to baseline. A significant reduction in the MRS score (32.8%; p < 0.05) was observed. Mirtazapine appears to be effective in reducing HF in breast cancer survivors. The more frequent side effect was somnolence. A sizeable compiliance problem has been observed due to the reluctance to take antidepressant drugs and to side effects.     

Transfer of the antidepressant mirtazapine into breast milk

AIMS: To investigate the transfer of mirtazapine and desmethylmirtazapine into milk and to calculate dose to the infant via milk. METHODS: Plasma and milk samples were obtained from eight breast-feeding women who were taking a median dose of 38 mg mirtazapine per day. Milk/plasma ratio (M/P) and infant doses were estimated by standard methods. The infants were examined clinically and in four infants blood was taken for analysis. RESULTS: Mean (95% confidence interval) relative infant doses for mirtazapine and desmethylmirtazapine (n = 8) were 1.5% (0.8, 2.2) and 0.4% (0.2, 0.6) respectively. The mean M/P (area under curve n = 4, single or paired samples n = 3) was 1.1 (0.7,1.5) for mirtazapine and 0.6 (0.5, 0.7) for desmethylmirtazapine. No adverse effects were seen. Mirtazapine was detected (1.5 microg l(-1)) in only one of four infants tested. CONCLUSION: We suggest that mirtazapine use by lactating women is safe for the breast-fed infant. Nevertheless, each decision to breast feed should always be made on the basis of an individual risk/benefit analysis.     

Improving antidepressant drugs: update on recently patented compounds

Background: According to the WHO, depression is a common condition that affects about 121 million people worldwide. Although the pathophysiological origin of this condition is still unknown, most of the known antidepressants enhance the extracellular availability of brain monoamines (serotonin and/or noradrenaline). Objective/method: We have searched for the potential drugs and targets addressed in the most recent patents. Hence, we have explored the Patent Database of the European Patent Office using the esp@cenet search engine for the period 2005 – 2008, looking for “anti depressants”. In addition, a search in the Medtrack database yielded information on pharmaceutical companies developing compounds as antidepressants, market size and their market prospects. Conclusions: We have found that, in general, the preferred targets to develop antidepressants continue to be those aiming the serotoninergic system and, in a less extend, the noradrenergic one; but, more particularly, those that aim several targets are preferred due to problems concerning the efficacy of highly selective drugs. Additionally, a small number of new systems are being targeted, such as the melatonergic. However, when looking at the pharma-market and the antidepressants in the pipeline, a new trend is observed in the developing of dual-action drugs that could be used in depression and schizophrenia therapy.     

Impact of Antidepressants on Cytokine Production of Depressed Patients in Vitro

The interplay between immune and nervous systems plays a pivotal role in the pathophysiology of depression. In depressive episodes, patients show increased production of pro-inflammatory cytokines such as interleukin (IL)-1β and tumor necrosis factor (TNF)-α. There is limited information on the effect of antidepressant drugs on cytokines, most studies report on a limited sample of cytokines and none have reported effects on IL-22. We systematically investigated the effect of three antidepressant drugs, citalopram, escitalopram and mirtazapine, on secretion of cytokines IL-1β, IL-2, IL-4, IL-6, IL-17, IL-22 and TNF-α in a whole blood assay in vitro, using murine anti-human CD3 monoclonal antibody OKT3, and 5C3 monoclonal antibody against CD40, to stimulate T and B cells respectively. Citalopram increased production of IL-1β, IL-6, TNF-α and IL-22. Mirtazapine increased IL-1β, TNF-α and IL-22. Escitalopram decreased IL-17 levels. The influence of antidepressants on IL-2 and IL-4 levels was not significant for all three drugs. Compared to escitalopram, citalopram led to higher levels of IL-1β, IL-6, IL-17 and IL-22; and mirtazapine to higher levels of IL-1β, IL-17, IL-22 and TNF-α. Mirtazapine and citalopram increased IL-22 production. The differing profile of cytokine production may relate to differences in therapeutic effects, risk of relapse and side effects.     

米氮平治疗大肠癌术后化疗相关焦虑抑郁的疗效观察

[目的]评价米氮平对大肠癌术后化疗患者焦虑、抑郁的疗效及化疗不良反应的影响.[方法]根据汉密尔顿焦虑—抑郁量表筛选出56例大肠癌术后化疗后出现焦虑、抑郁的患者,随机分为米氮平组和对照组,观察8周后评定米氮平对化疗患者焦虑、抑郁的疗效及对化疗不良反应的影响.[结果]米氮平组在化疗后第2、4及8周的焦虑、抑郁量表评分均低于化疗前水平(P＜0.05),且明显低于同期对照组(P＜0.01).米氮平组恶心呕吐、失眠等不良反应显著减轻(P＜0.05),且米氮平不加重骨髓抑制、肝肾功能损害及神经毒性等化疗不良反应(P＞0.05).[结论]米氮平干预大肠癌术后化疗伴发焦虑、抑郁障碍患者疗效显著,可有效改善生活质量,减轻化疗引起的不良反应.