马普替林与阿米替林治疗抑郁症对比

报道国产马普替林（男性２１例，女性７例；年龄３７±ｓ１３ａ）与阿米替林（男性１９例，女性９例；年龄３８±１１ａ）治疗５６例抑郁症的对照实验。开始剂量均为５０ｍｇ／ｄ，ｌｗｋ内加至１５０－２５０ｍｇ／ｄ，共４ｗｋ。结果显示：２个药抗抑郁疗效相仿，ＨＡＭＤ总分的减分，差别无显著意义（Ｐ＞０．０５）。２个药主要不良反应为口干、便秘、头晕、视物模糊等抗胆碱能症状。     

Comparison of the efficacy of sustained-release amitriptyline with maprotiline in the treatment of depressive illness

Summary

Forty consecutive psychiatric patients referred to hospital with a diagnosis of depressive illness were randomly allocated to double-blind treatment with either 50?mg sustained-release amitriptyline or 75?mg maprotiline in night-time dosage. The dosage was doubled after I week. Rating scale assessments were carried out regularly over a 5-week period. The results indicated that there was a significant improvement with both drugs which occurred at approximately the same speed and to the same extent. Side-effects were complained of by approximately as many patients on both forms of treatment.     

Urinary 3-methoxy, 4-hydroxyphenylethylene glycol and therapeutic response to maprotiline and indalpine in major depression

Summary The potential value of pretreatment urinary 3-methoxy, 4-hydroxyphenylethyleneglycol (MHPG) levels to predict the therapeutic response to antidepressants was studied by measuring urinary MHPG output in 42 depressed inpatients treated with a selective inhibitor of serotonin (Indalpine) or noradrenaline (Maprotiline) reuptake.Among the 42 depressed inpatients there were 33 cases of major depressive episode. Patients were treated for at least 3 weeks, firstly with intravenous infusions of maprotiline or indalpine which have been administered at random. No difference in pretreatment urinary MHPG levels was found between the responders to indalpine (1.08±0.48g/24 h/mg of creatinine) and the responders to maprotiline (1.15±0.62g/24 h/mg of creatinine). However, there was a difference in the pretreatment levels of urinary MHPG between the non-responders to indalpine (0.56±0.28g/24 h/mg of creatinine) and the non-responders to maprotiline (1.37±0.68g/24 h/mg of creatinine). No correlation between this biochemical parameter and HDRS score was found.These results indicate that, in this study, there is no obvious relationship between the pretreatment urinary MHPG levels in depressed patients and their therapeutic response to specific inhibitors of noradrenaline or serotonin reuptake. However, there was a positive trend towards a lower pretreatment MHPG level to be associated with lack of response to indalpine.     

A comparison of the effect of lofepramine,maprotiline and placebo on information processing in healthy volunteers

Single oral doses of lofepramine (140 mg), maprotiline (100 mg), and placebo were administered in a randomized three-way crossover design with 1 week wash-out between administrations to 12 healthy male volunteers. Before, and 1, and 3 h post-administration a battery of performance tests was administered which included a digit-matching paradigm and a reaction test separating recognition and motor time. In contrast to maprotiline, lofepramine did not impair speed and accuracy of cognitive performance.     

Dexamethasone suppression test as a predictor of drug treatment response

1. The possible predictive value of cortisol non-suppression by dexamethasone for therapeutic response to antidepressants was investigated both in “endogenous” and “neurotic” depression. Seventy-four female patients who fulfilled the RDC of Major Depressive Disorder (Study 1) and 44 female patients with the diagnosis of “Neurotic Depression” of ICD-9 (Study 2) were given DST and then treated with antidepressants, their clinical response being assessed after four weeks of drug treatment.

2. Forty-three out of the 74 patients with Primary Major Depression were non-suppressor. The DST non-suppressors showed a significantly more frequent therapeutic response to maprotiline than to amitriptyline. DST suppressors, on the other hand, responded better to amitriptyline treatment than non-suppressors.

3. In the neurotic depression group 23 patients were subclass ified as Primary Minor Depression, and 52 % of them showed non-suppressor response to DST. Twenty-one patients were diagnosed as Secondary Depression, with a history of chronic neurosis. One patient only (5 %) was the non-supressor. Patients with Primary Minor Depression showed good therapeutic response to antidepressants more frequently, than patients with Seconday Depression.     

Comparison between a serotonin and a noradrenaline reuptake blocker in the treatment of depressed outpatients. A cross-over study

Seventy-five outpatients with major depressive disorder (RDC) were randomly referred to treatment with a dominant serotonin (5-HT) reuptake blocker (zimeldine, 100 mg, b.i.d. n = 40) or a dominant noradrenaline (NA) reuptake blocker (maprotiline, 75 mg, b.i.d. n = 35). Seven patients on each drug were non-responders after up to 4 weeks of treatment and were after a washout week crossed over to the other drug for up to another 8 weeks of treatment. There was a significant and similar improvement after 4 weeks of treatment with the second drug. After up to 8 weeks of treatment all patients but one in each group were much improved with the second drug. The existence of two biochemical subgroups of depression is discussed.     

A multinational, double-blind trial with a new antidepressant maprotiline (Ludiomil) and amitriptyline

An account is given of a multinational double-blind trial, in which the tetracyclic antidepressant maprotiline (Ludiomil®) was compared with amitriptyline. Two hundred and eleven patients participated; of these 191 completed the trial. In 68% of the cases, endogenous depression was diagnosed; the remaining cases were diagnosed as reactive or other depressions. Hamilton's Rating Scale for Depression was used, and unwanted effects were registered on standardized scales. No statistically significant difference in antidepressive effect assessed by Total Hamilton Score (THS) and global evaluation was found between maprotiline and amitriptyline. However, a significant difference in favour of maprotiline was shown in the global evaluation of unwanted effects and as regards the individual symptoms “blurred vision” and “sweating”. The laboratory tests disclosed no positive difference between the two preparations. Advantages and disadvantages of multicentre trials are discussed and the value of standardized scales is pointed out. Factor analysis carried out on the same material is mentioned.     

Visual perseveration: a new side effect of maprotiline

OBJECTIVE: The aim of this paper is to describe a case of visual perseveration including palinopsia during maprotiline therapy. METHOD: A single case report. RESULTS: The patient, a 56-year-old depressive man, suffered from visual perseveration during maprotiline therapy. The visual perseveration was dose-related and disappeared with reduction and cessation of the therapy. CONCLUSION: The present findings suggest that maprotiline can induce visual perseveration including palinopsia in some patients.     

米氮平治疗广泛性焦虑症的疗效及安全性

目的:探讨米氮平治疗广泛性焦虑症的疗效和不良反应.方法:对60例广泛性焦虑症患者随机分为试验组及对照组,分别服用米氮平15～30mg·d-1和马普替林50～150mg·d-1,疗程均为6周.于治疗前及治疗后第1,2,4,6周末进行汉密尔顿焦虑量表(HAMD)及不良反应量表(TESS)评定疗效和不良反应.结果:试验组治疗广泛性焦虑症的显效率84.69%,有效率100%;对照组显效率66.67%,有效率88.89%,但两组比较经Ridit分析差异无显著性(P＞0.05).不良反应方面比较米氮平TESS评分显著低于马普替林(p＜0.05).结论:米氮平是治疗广泛性焦虑症的快速、安全、有效的药物.     

丹栀逍遥散对抑郁症患者神经免疫内分泌系统的影响

目的观察丹栀逍遥散对抑郁症患者神经免疫内分泌系统的影响。方法采用随机双盲对照法,将63例抑郁症患者分为两组,分别用丹栀逍遥散（中药组32例）和麦普替林（西药组31例）治疗,并于治疗前及用药2、4、6周后评定HAMD量表,治疗前及用药6周后测定患者血清5-羟色胺（5-HT）、去甲肾上腺素（NE）、脑源性神经营养因子（BDNF）、血清皮质醇（CORT）、IL-6、IL-1β水平。结果治疗2周后两组HAMD总分均显著降低（P〈0．01）,且西药组显著低于中药组（P〈0．01）,同时西药组焦虑／躯体化、认知障碍、绝望感三因子评分均低于中药组（P〈0．05或P〈0．01）,治疗4、6周后两组HAMD总分及各因子评分均显著降低（P〈0．01）,组间比较差异无显著性。治疗6周后两组血清5．HT、BDNF水平均升高（P〈0．01）,IL-6水平均降低（P〈0．05,P〈0．01）,中药组CORT水平降低（P〈0．01）,西药组NE水平升高（P〈0．01）。结论丹栀逍遥散可通过调整抑郁症患者5-HT、BDNF、CORT、IL-6等水平干预抑郁症,改善临床症状。