Trajectories of recovery in depressed Parkinson's disease patients treated with paroxetine or venlafaxine

IntroductionDepression is considered a syndrome with a constellation of symptoms that are frequently categorized into 3 domains including affective, somatic and cognitive. There has been limited research into the domain specific magnitude or relative timing of treatment response in patients with Parkinson's disease (PD). In addition, antidepressant trials involving patients with PD have demonstrated a similar robust placebo response to that seen in other populations. However, the timing of the placebo response has not been carefully studied.MethodsWe studied differential responses to antidepressant treatment in affective, somatic and cognitive domains of depression. Patients were treated for twelve weeks with placebo, venlafaxine or paroxetine as part of the Study of Antidepressants in Parkinson's Disease (SAD-PD) randomized controlled trial. Depressive symptoms were evaluated with three commonly used rating scales.ResultsAll symptom domains improved during the study period, There was a significant placebo effect, especially in the first two weeks that had diminished by week 12. Compared to placebo, the affective symptoms significantly improved during treatment as early as week 4, followed by the somatic symptoms of depression in week 6 and cognitive symptoms in week 8. The largest response was seen in the affective domain.ConclusionIn depressed PD patients treated with venlafaxine or paroxetine, affective symptoms improved first, followed by somatic symptoms and cognitive symptoms. These findings could guide patient counselling and increase patient compliance by informing about the expected treatment responses. The substantial placebo effect underlines the importance of a sufficiently long study period in future studies.     

怡诺思与阿普唑仑治疗广泛性焦虑症对照研究

目的探讨怡诺思治疗广泛性焦虑症的临床疗效和安全性。方法将68例广泛性焦虑症患者随机分为怡诺思组34例和阿普唑仑组34例。怡诺思组治疗剂量75~150mg·d-1,阿普唑仑组为1.2~3.6mg·d-1观察时间均为6w。治疗前与治疗第1,2,4,6w末采用汉密顿焦虑量表、焦虑自评量表、副反应量表评定临床疗效和副反应。结果两组疗效相当,差异无显著性(P>0.05);阿普唑仑组起效时间快于怡诺思组,但远期疗效差于怡诺思组;怡诺思组副反应明显少于阿普唑仑组(P<0.05)。结论怡诺思治疗广泛性焦虑疗效肯定,安全性高,依从性好。     

文拉法辛对脑卒中后抑郁患者的神经功能缺损及生活自理能力的影响

目的研究文拉法辛治疗脑卒中后抑郁患者时对神经功能缺损及生活自理能力的影响。方法选取2013-04—2014-12我科60例脑卒中后抑郁患者,随机分为对照组及研究组,对照组采用黛力新0.5mg/d治疗,研究组给予文拉法辛75mg/d治疗,此外,所有入选患者均接受相同的康复治疗和常规药物治疗,疗程共6周。在治疗前及治疗后第2、4、6周末,用汉密尔顿抑郁评定量表(HAMD)、焦虑量表(HAMA)和巴氏指数(BI)及美国国立卫生院卒中评分(NIHSS)评估疗效。结果 2组治疗后HAMD、HAMA得分较治疗前明显下降(P0.05)。治疗前BI及NIHSS评分差异均无统计学意义(P0.05),治疗第2周后NIHSS评分,治疗组较对照组明显降低(P0.05),而BI 2组无明显差异(P0.05);起病后6周,研究组BI较对照组升高(P0.01)。结论文拉法辛治疗脑卒中后抑郁的疗效可靠,并能改善患者神经功能及日常生活能力,促进肢体神经功能的康复,从而提高患者的生活质量。     

In vivo studies of effects of antidepressants on parotid salivary secretion in the rat

Tricyclic antidepressants (TCA) are well-known xerogenic drugs, while antidepressants such as selective serotonin reuptake inhibitors (SSRI) are considered less xerogenic. The antimuscarinic effect of the TCAs has been considered to be the principal mechanism causing a dry mouth. Although the muscarinic receptor is commonly targeted by xerogenic pharmaceuticals, the salivation reflex arc may be affected at other levels as well. We currently wondered whether or not antidepressants exert an inhibition of the salivary reflex not only at the glandular level but at a central level as well. In this study, the effects of a TCA (clomipramine), a SSRI (citalopram) and a serotonin-noradrenaline reuptake inhibitor (SNRI; venlafaxine) were examined on reflex- (0.5 M citric acid applied on the tongue) and methacholine-evoked salivary secretion. While all three compounds inhibited citric acid-evoked secretion (−40 to −60% at 5 mg/kg i.v. of the antidepressants), only clomipramine inhibited methacholine-evoked secretion (−30% at 5 mg/kg i.v.). On the contrary, both citalopram and venlafaxine increased the methacholine-evoked secretion (+44 to 49%). This was particularly obvious for the salivary protein output (>200%). In the presence of α- and β-adrenoceptor antagonists, the citalopram- and venlafaxine-induced increases were reduced. Thus, antidepressants irrespective of type may exert xerogenic effects by inhibiting the salivary reflex in the central nervous system. However, while TCAs may also hamper the secretory response by antimuscarinic effects, the SSRI and the SNRI groups of pharmaceuticals seem to lack this additional xerogenic mechanism indicating a better therapeutic profile and better opportunities for pharmacological treatment of drug-induced xerostomia.     

盐酸文拉法辛缓释片Beagle犬体内药动学及生物等效性研究

目的 研究盐酸文拉法辛缓释片在Beagle犬体内的药动学和生物等效性。方法 8条健康Beagle犬随机分成2组,采用双周期、双交叉、单剂量分别ig盐酸文拉法辛缓释片受试制剂或参比制剂75 mg,清洗期为1周;建立血浆中盐酸文拉法辛液相色谱-质谱联用（LC-MS/MS）检测方法,进行方法精密度、准确度、提取回收率、基质效应、稳定性方法学验证;测定给药前（0 h）及给药后2、3、4、5、6、8、10、12、14、16、24、36、48、72 h血浆中盐酸文拉法辛血药浓度,运用DAS 2.1.1软件计算其药动学参数,并评价其生物等效性。结果 LC-MS/MS方法学经验证符合检测要求,受试制剂和参比制剂主要药动学参数分别如下：T_1/2分别为（7.16±2.34）和（6.95±1.57） h、Cmax分别为（522.89±201.12）和（515.22±159.29）ng/mL、T_max分别为（10.38±1.69）和（10.50±2.07）h、AUC_0-t分别为（8 398.64±3332.86）和（8 050.71±2103.15）ng·h/mL、AUC_0-∞分别为（8 701.60±3303.29）和（8 450.01±2273.45）ng·h/mL;以参比制剂为参考,受试制剂AUC_0-∞相对生物利用度为（101.0±13.1）%。结论 盐酸文拉法辛缓释片受试制剂与参比制剂在Beagle犬体内具有生物等效性。     

度洛西汀和文拉法新治疗老年期抑郁障碍的对照研究

目的：对照研究度洛西汀和文拉法新治疗老年期抑郁障碍的疗效、安全性。方法110例老年抑郁症患者随机分为研究组和对照组,各55例,研究组给予度洛西汀口服,对照组给予文拉法新口服,在治疗前、治疗1、2、4、8周末采用24-汉密尔顿抑郁量表（HAMD）进行疗效评定, TESS量表进行不良反应评定。结果在治疗1周末研究组和对照组HAMD评分均有下降,差异无统计学意义（P〉0.05）,在治疗2、4、8周末HAMD评分差异无统计学意义（P〉0.05）。TESS量表总体评价差异无统计学意义（P〉0.05）,文拉法新引起血压升高较多,度洛西汀片引起恶心、呕吐较多。结论度洛西汀和文拉法新起效时间、临床疗效、总体副反应相当,度洛西汀质优价廉,值得推广。     

文拉法辛与米氮平治疗抑郁症对照研究

目的：比较文拉法辛与米氮平治疗抑郁症患者的疗效与不良反应。方法：将60例抑郁症患者随机分为两组,分别给予文拉法辛和米氮平治疗,疗程8周。用汉密尔顿抑郁量表（HAMD）、不良反应量表（TESS）评定疗效和不良反应。结果：文拉法辛与米氮平对抑郁症疗效相仿,不良反应少。结论：文拉法辛和米氮平都可以作为抑郁症的首选药物。     

文拉法辛缓释胶囊治疗抑郁和焦虑障碍共病60例

目的 研究文拉法辛缓释胶囊治疗抑郁、焦虑障碍共病的疗效及安全性.方法 将120例抑郁、焦虑障碍共病患者随机均分为文拉法辛缓释胶囊组(研究组)和选择性5-羟色胺再摄取抑制剂组(对照组),进行对照研究,疗程12周,采用汉密顿焦虑量表、汉密顿抑郁量表、药物副作用量表评定临床疗效和不良反应.结果 研究组抗焦虑、抗抑郁作用均较对照组起效快(P＜O.05或P＜O.01),抗焦虑疗效优于对照组(P＜0.05);治疗12周末两组抗抑郁疗效相当.结论 文拉法辛缓释胶囊治疗抑郁、焦虑障碍共病起效快、疗效显著、安全性高、依从性好.     

曲唑酮治疗老年期抑郁症的研究

目的 探讨曲唑酮治疗老年期抑郁症的疗效.方法 60例符合诊断标准的老年期抑郁症患者随机分为曲唑酮组和文拉法辛组,疗程8周.采用汉密尔顿抑郁量表(HAMA),评定疗效.采用治疗中需处理的不良反应症状量表(TESS)评定安全性.结果 在第1周末研究组(曲唑酮组)有效率为30.00%;对照组(文拉法辛组)有效率为10.00%.两组有效率有显著性差异(X2=3.85、P＜0.05).治疗8周末研究组总有效率93.33%,对照组总有效率86.67%,两组总有效率无显著性差异(X2＝0.187、P＞0.05),说明两者总体疗效相当.两组TESS评分在治疗后1、2、4及8周末差异均无统计学意义(P＞0.05).结论 曲唑酮治疗老年期抑郁症起效快,安全性好,副作用少.     

文拉法辛缓释剂治疗广泛性焦虑症的临床研究

目的探讨文拉法辛缓释剂治疗广泛性焦虑症的临床疗效和安全性。方法将136例广泛性焦虑症患者随机分为文拉法辛缓释剂组68例和阿普唑仑组68例。怡诺思组治疗剂量75~150m g/d,阿普唑仑组为1.2~3.6m g/d,观察时间均为6周。治疗前与治疗第2、4、6周末采用汉密尔顿焦虑量表、焦虑自评量表、副反应量表评定临床疗效和副反应。结果两组疗效相当,差异无显著性（P〉0.05）;阿普唑仑组起效时间快于文拉法辛缓释剂组,但远期疗效差于文拉法辛缓释剂组;怡诺思组副反应明显少于阿普唑仑组（χ2=7.49,P〈0.01）。结论文拉法辛缓释剂治疗广泛性焦虑疗效肯定,安全性高,依从性好,值得临床推广应用。