西酞普兰治疗抑郁症

目的：观察选择性五羟色胺再摄取抑制剂西酞普兰的抗抑郁作用及其不良反应。方法：用该药治疗各种抑郁性障碍６０例。用Ｈａｍｉｌｔｏｎ抑郁量表和临床总体印象评定临床疗效。结果：在５４例完成６周治疗的病人中,该药临床显效率达６９％,总有效率为９１％。对抑郁症病人所伴发的焦虑和睡眠障碍也有一定的治疗效果。不良反应轻微,无一例因药物不良反应导致治疗中断。结论：提示西酞普兰是一种安全有效的抗抑郁药物。     

45岁以上抑郁病人与正常人心理、免疫功能的比较研究

目的：探讨老年及老年前期抑郁障碍的心理和免疫功能改变。方法：对６３例年龄４５岁以上的抑郁病人以ＳＣＬ－９０、ＨＡＭＤ、ＨＡＭＡ、ＥＰＱ、ＬＥＳ等量表进行评定，三个月后随访评定，并进行单因素及多因素分析；对其中２９例病人取血进行淋巴细胞增殖试验及ＩＬ－２活性测定等，三个月后随访检测，并进行相关因素分析。结果：与１２名正常对照者比较，病人各量表总分、因子分及ＥＰＱ之神经质分显著增高，外周血淋巴细胞及ＩＬ－２活性显著降低。治疗三个月后，ＳＣＬ－９０、ＨＡＭＤ、ＨＡＭＡ总分及大部分因子分均下降，淋巴增殖显著增高，ＩＬ－２活性有所增高。结论：抑郁程度明显受人格、性别、婚姻状况及疾病类型等因素影响，抑郁程度越严重免疫功能受抑制越明显。     

脑功能保健仪治疗失眠症临床疗效观察

目的 探讨非药物治疗失眠症疗效评估。方法 对符合ＣＣＭＤ－Ⅱ－Ｒ诊断标准的９９例病人，应用ＢＷ－３０８型脑功能保健仪治疗，每日一次，每次３０分钟，１５次为一疗程。结果 显效率为７５．７％。治疗的睡眠障碍自评量表均分明显下降，ＳＡＳ及ＳＤＳ量表治疗后均分都有明显下降，有非常显著差异。结论 脑功能保健仪是治疗失眠的一种有效的辅助设备。在神经症治疗中如何广泛应用，值得深入研究。     

舒血宁合并阿米替林治疗抑郁症多中心双盲对照研究

目的：观察合并应用银杏叶提取物能否提高经典抗抑郁药物阿米替林的抗抑郁疗效,能否减少阿米替林的不良反应。方法：采用多中心随机双盲对照研究方法。一组病人给予阿米替林合并银杏叶提取物（研究组）,一组给予阿米替林与安慰剂（对照组）,治疗８周。共纳入２４０例符合ＣＣＭＤ－２－Ｒ抑郁症标准的病人。结果：（１）研究组疗后Ｈａｍｉｌｔｏｎ抑郁量表平均减分率显著高于对照组;（２）研究组治疗结束时ＣＧＩ严重度显著低于对照组;（３）研究组Ａｓ－ｂｅｒｇ副作用量表治疗后增分显著低于对照组。（４）研究组的疗效指数显著高于对照组。结论：银杏叶提取物与阿米替林合并应用可以显著增强后者的抗抑郁疗效,并且能显著减少后者的不良反应,因而提高了后者的疗效指数。     

度洛西汀治疗抑郁症伴发糖尿病疗效研究

目的 观察5-羟色胺/去甲肾上腺素再摄取抑制剂度洛西汀治疗抑郁症伴发糖尿病的疗效及不良反应.方法 用该药治疗抑郁症伴发糖尿病30例.进行2、4和8周的观察,度洛西汀30～60mg/d,用汉密尔顿抑郁量表(HAMD)评定疗效,药物副反应量表(TESS)评定药物不良反应.空腹和餐后2小时血糖用于血糖控制的监测.结果 完成治疗后,病人的HAMD总分显著下降,均达到统计学意义(t=2.66,2.77,2.81;P＜0.01),显效率为63％.不良反应轻微(r=0.33,P＞0.05),无1例因药物不良反应导致治疗中断.结论 度洛西汀治疗抑郁症伴发糖尿病患者的抑郁症状有效,安全.     

脑外伤病人家属心理健康状况调查

本文应用“心理卫生症状自评量表”（ＳＣＬ－９０），对３１名脑外伤病人家属进行测评，并与正常人对照分析，结果显示：焦虑因子分两组差异极为显著，躯体化、抑郁、敌对因子分差异显著。提示脑外伤病人家属也需心理疏导，必要时应用抗焦虑、抑郁药物。     

高血压患者心理状况调查

对３６例高血压病人运用精神症状自评量表和抑郁自评量表，对精神症状的分布和是示，ＳＣＬ－９０的躯体化，人际关系，抑郁，敌对性等因子分明显高于国内常模，ＳＤＳ也提示大部分因子分明显高于国内常模。提示高血压病与心理因素有密切关系。     

功能性消化不良患者抗焦虑、抑郁治疗前后的社会功能研究

目的：探讨功能性消化不良（ＦＤ）患者抗焦虑、抑郁治疗前后的社会功能。方法：采用社会功能缺陷筛选量表（ＳＤＳＳ）对２００例患者进行了评定,将有社会功能缺陷的７２例患者随机分为研究组和对照组给予常规治疗,研究组同时给予抗焦虑或（和）抗抑郁药物治疗,疗程２个月。结果：ＦＤ患者的社会功能缺陷发生率为３６％（７２／２００）。社会功能缺陷与性别及情绪障碍存在与否有关。治疗后ＳＤＳＳ评分研究组明显低于对照组（Ｐ     

恶性肿瘤患者心理状态调查

目的：了解恶性肿瘤患者心理状态。方法：采用90项症状清单（SCL－90）、汉密顿焦虑量表（HAMA）、汉密顿抑郁量表（HAMD）对49例恶性肿瘤患者进行测试。结果：恶性肿瘤患者SCL－90各因子分与全国常模相比，除人际关系、偏执外，躯体化、强迫、抑郁、焦虑、精神病性等因子分显著高于常模，而敌对性、恐怖等因子分明显低于常模，阳性总分显著高于常模，HAMA评定77．6％的恶性肿瘤患者存在焦虑症状，HAMD评定91．4％的恶性肿瘤患者存在抑郁症状。结论：在治疗恶性肿瘤过程中，不但要医治病人躯体上的痛苦，还要对病人的精神不良影响给予足够的重视。     

万拉法新治疗脑卒中后抑郁状态的临床研究

目的：探讨万拉法新治疗脑卒中后抑郁状的疗效。方法：采用汉密尔顿抑郁量表、副反应量表进行评定。对36例脑中抑郁状（PSD）患者进行4周的万拉法新治疗研究。结果：89％的病人有效，80％d的病人治愈，副反应少而轻微。结论：万拉法新是治疗PSD安全、有效、耐受良好的药物。     

Discontinuation of antidepressant drugs during electroconvulsive therapy: a controlled study

BACKGROUND: The concurrent use of antidepressant drugs with ECT is recommended by a recent ECT guideline. The study aimed to examine differential therapeutic and side effect responses when antidepressants are discontinued or not during ECT. METHODS: This study compared the effectiveness and side effect profile of unilateral ECT with antidepressant drugs (Group-1) or unilateral ECT with drug placebo (Group-2) in 30 major depressive disorder (DSM-IV) patients on antidepressants using a prospective randomised trial. Hamilton Rating Scale for Depression (HRSD), Montgomery Asberg Depression Rating Scale (MADRS), UKU scale, Columbia ECT side effect check list were used. The assessments were carried out before starting ECTs and at fixed intervals thereafter for four weeks. In addition, at six weeks a follow-up assessment was carried out using HRSD. ECTs were stopped after four weeks or earlier if patient obtained HRSD scores <8 and remained so for one week. RESULTS: Continuation of antidepressant drugs with ECT conferred no therapeutic advantage. Barring tricyclic antidepressant induced anticholinergic side effects, no differential side effect profile was noted. At follow-up none relapsed in Group-2 and the mean HRSD scores between the groups did not differ. Limitation: The antidepressant treatment prior to ECT was uncontrolled. In addition, the design was not strictly double-blind. CONCLUSION: The study failed to support an advantage with antidepressant continuation during an ECT course in major depressive disorder.     

The impact of comorbid anxiety disorders on the course of dysthymic disorder: a 5-year prospective longitudinal study

BACKGROUND: Few studies have examined the impact of comorbid anxiety disorder on the course of dysthymic disorder despite the high rate of comorbidity between these disorders. This research prospectively examines the naturalistic course of dysthymic disorder in patients with and without a comorbid anxiety disorder over a 5-year period. METHODS: Thirty-two comorbid patients and 54 non-comorbid patients with dysthymic disorder were assessed at three different time points (baseline, 30 months, and 60 months). Follow-up assessments included the Longitudinal Interval Follow-Up Evaluation and Hamilton Rating Scale for Depression (HRSD). RESULTS: The rate of recovery from dysthymic disorder was significantly lower in patients with (31.3%) than without (61.1%) comorbid anxiety disorders and, at all three time points, patients with comorbid anxiety had significantly higher HRSD scores. The estimated recovery rate from anxiety disorders was 53.8%. Only five of the comorbid patients recovered from both dysthymic disorder and all anxiety disorders during follow-up. Including new onsets, 72.1% of patients experienced an episode of an anxiety disorder during the 5 years. LIMITATIONS: There was no pure anxiety disorder group and patients were asked to report on relatively lengthy follow-up intervals. CONCLUSIONS: While the course of dysthymic disorder is debilitating, these results suggest that the prognosis for patients with a comorbid anxiety disorder is even poorer.     

西酞普兰与氟西汀治疗老年期抑郁障碍的对照研究

目的:比较西酞普兰和氟西汀治疗老年期抑郁障碍的疗效和安全性。方法:将符合老年期抑郁障碍的门诊患者50名随机分为2组,分别给予西酞普兰和氟西汀治疗6周。采用汉密尔顿抑郁量表(HAMD17)、临床总体印象量表(CGI)和副反应量表(TESS)评定疗效和不良反应。结果:在完成6周治疗的42 例病人中,西酞普兰组显效率为86%,氟西汀组为80%,两组疗效差异无显著意义(X~2=0.35,P>0.05)。治疗一周以后,西酞普兰组HAMD 评分低于氟西汀组,差异有显著意义(P<0.05)。两组的副反应轻微,无一例因药物反应而脱落,安全性良好。结论:与氟西汀相比,西酞普兰治疗老年期抑郁障碍的疗效和安全性类似,但是起效较快。     

Single photon emission tomography with 99m Tc-HMPAO in Arab patients with depression

BACKGROUND: This study investigates the rate of cerebral blood flow (rCBF) in Arab patients wth depression. METHODS: Forty-four patients with DSM-III-R major depressive disorders were studied at rest using single photon emission computerized tomography (SPECT) with 99m Tc-HMPAO in comparison with 20 normal controls. All patients were assessed using the Hamilton Rating Scale for Depression (HRSD). RESULTS: The depressed group showed greater rCBF in left and right posterior frontal and parietal cortical regions than normal controls. Within the depressed group, patients with the least severe illness (HRSD < 20) had significantly lower rCBF than normal controls, whilst those with moderately severe (HRSD 20-29) and severe (HRSD > 30) had significantly greater rCBF in most cortical regions than normal controls. Symptom scores, derived from the HRSD were predicted by rCBF principally increased rCBF in the left frontal cortex. CONCLUSIONS: These results suggest a generalized cerebral activation principally in the frontal cortex which is in contrast to the results of most previous studies but more in line with the results of studies of induced affect and some studies of depression subsyndromes.     

Multicenter double-blind randomized parallel-group clinical trial of efficacy of the combination clomipramine (150 mg/day) plus lithium carbonate (750 mg/day) versus clomipramine (150 mg/day) plus placebo in the treatment of unipolar major depression

BACKGROUND: The therapeutic efficacy of adding lithium to an ongoing antidepressant in resistant depression is well known. However there is less data concerning the efficacy of giving lithium and antidepressant concurrently from the start of treatment. METHODOLOGY: The primary objective of this study was to compare the efficacy of a combination of clomipramine+lithium (C+L) with that of clomipramine+placebo (C+P) in-patients with unipolar major depression, during the first 11 days of treatment. Secondary objectives were the assessment of effectiveness after 6 weeks and assessment of the safety of the combination clomipramine and lithium carbonate. C+L and C+P groups were compared for 6 weeks in a multicenter randomized trial of 141 patients hospitalized with a DSM-IV diagnosis of major depression. Efficacy was evaluated using the standard MADRS and CGI scales. RESULTS: Analysis of the 'as treatment ITT' population showed: the percentage reduction in MADRS scores between D0 and D11 in this population was better in the C+L group but not statistically significant (C+L: 32.1 vs. C+P: 27.4, P=0.07). Nevertheless, the comparison of mean MADRS scores showed a significant difference in the C+L group on days 4 (C+L: 25.1 vs. C+P: 27.8) and 7 (C+L: 18.6 vs. C+P: 21.5), P<0.05, and approaching significance on day 11 (C+L: 14.6 vs. C+P 17.2, P=0.054). On day 7, the number of patients in total remission was threefold higher in the C+L group than in the C+P group (15 vs. 4%, P<0.05) and twofold on day 11 (29 vs. 14%, P<0.05). CGI severity score showed C+L was superior to C+P on days 4, 7 and 11 and CGI improvement score was better in C+L group on day 11 (P<0.05). After 6 weeks of treatment no statistical difference was found between the two groups from the clinical point of view. Safety based upon clinical and laboratory parameters was satisfactory in both groups during the 6 weeks of the study. LIMITATIONS: Patients with bipolar disorder, previously treated with clomipramine or with any other mood stabilizers during the previous week; or with suicide attempt during the current episode with a score > or =3 for item 10 of the MADRS were excluded from the study. CONCLUSION: The results of this study suggests that lithium slightly to moderately potentiates antidepressant treatment in unipolar non-refractory patients with severe major depression in the first days of treatment but not as significantly as for the bipolar population.     

Reboxetine versus imipramine in the treatment of elderly patients with depressive disorders: a double-blind randomised trial

BACKGROUND: Depression in older people is often unrecognised and untreated or under-treated. Antidepressant treatment may itself exacerbate a pre-existing illness, interact with concomitant medications or produce undesirable cognitive and sedative side effects. Newer antidepressants may offer advantages in terms of a lesser burden of adverse effects. METHODS: The comparative tolerability of the unique selective noradrenaline reuptake inhibitor (selective NRI) reboxetine (4-6 mg/day; n = 176) and that of imipramine (50-100 mg/day; n = 171) was assessed in an elderly ( > 65 years) cohort of depressed or dysthymic patients in an 8-week, double-blind, multicentre trial. Comparative efficacy was also assessed. RESULTS: Overall, 68% of patients in the reboxetine group experienced adverse events compared with 71% in the imipramine group. Reboxetine-treated patients were less likely to develop hypotension and related symptoms (7% vs. imipramine 16%) or cardiovascular disorders (12.5% vs. imipramine 21.1%), while those treated with imipramine were less likely to experience insomnia (6.3% vs. 2.9%). Adverse events were more often assessed as related to treatment (43%) and moderate to severe in intensity (73%) with imipramine than with reboxetine (33% and 65%, respectively). Furthermore, there were fewer serious adverse events in the reboxetine-treated group (P = 0.019). The reduction in the Hamilton Rating Scale for Depression (HAM-D) was comparable between the treatment groups in the total population. At the last assessment, the majority of patients in both treatment groups were assessed as normal to borderline or mildly ill using the Clinical Global Impression (CGI) scale. In a subanalysis of the dysthymic patients a modest but significant difference in favour of imipramine was observed for both HAM-D and CGI assessments. This may have been a reflection of a trend towards more severe depressive symptoms at baseline in the reboxetine group. CONCLUSIONS: Reboxetine is as effective as imipramine in the treatment of depression in elderly patients but is at least as well tolerated with a lower risk of hypotension and related symptoms, fewer serious adverse events, adverse event-related withdrawals and treatment-related adverse events.     

Sertraline in the treatment of mixed anxiety and depression disorder

BACKGROUND: Mixed anxiety and depression disorder (MAD) has been recognized in ICD-10 as a diagnostic group including those anxious and depressed patients which do not fit sufficient criteria for any major axis I disorders. MAD is usually treated as a combination of anxiety and depression, although there are data indicating that selective serotonin reuptake inhibitors (SSRIs) might be active on both anxiety and depression. METHOD: 38 patients diagnosed of MAD according to ICD-10 criteria were treated with flexible doses of sertraline for 8 weeks. Benzodiazepines were not allowed during the trial. Efficacy was evaluated with the Clinical Global Impression (CGI) improvement scale and with Hamilton's depression and anxiety Scales. Personality scales, including the Cloninger's TCI and Eysenck's EPQ, were used to test the predictive value of personality traits in the response to treatment. RESULTS: Anxiety was reduced by 55% and depression by 60% in Hamilton scales. At week 8, 29 patients were considered responders (CGI 1 ó 2). Two patients discontinued the trial, only one of them due to adverse events. The mean dose of sertraline was 83.4 mg/day. CONCLUSION: Sertraline showed an excellent tolerability in patients with mixed anxiety-depression disorder despite high levels of baseline anxiety. The response level was high and similar to that reported for patients with major depression. These results warrant further controlled trials to assess the efficacy of SSRIs in MAD.     

Partial sleep deprivation therapy combined with sertraline induces more rapid improvements in quality of life items in major depressive disorder

BACKGROUND: Total or partial sleep deprivation was showed to have rapid antidepressive effects in depression. Sleep deprivation therapy in major depression constitutes insufficient antidepressive treatment response and depressive symptoms reoccur after one night of recovery. Combination of antidepressant medication with sleep deprivation therapy is generally indicated. These combination therapies were found more favorable overall therapeutic effect than antidepressive monotherapy. METHODS: In this study, we examined the Quality of Life changes with the antidepressive therapy using partial sleep deprivation plus sertraline and sertraline monotherapy in patients with major depressive disorder. Thirteen patients received six partial sleep deprivation therapies in addition to sertraline, that sleep schedule in deprivation nights started at 11:00-12:00 p.m. to 03:00 a.m. and 11 patients treated with sertraline monotherapy as a control group. Quality of Life was evaluated with the WHOQOL-100, depression and the accompanying anxiety were also assessed at baseline and at the end of the 4th week. RESULTS: Patients treated with combination therapy improved significantly and more rapidly. Rapid improvement in quality of life in major depressive disorder was showed in patients treated with combination of late partial sleep deprivation and sertraline. LIMITATIONS: Small sample size, the lack of placebo group and short duration of the study are the main limitations. CONCLUSIONS: In clinical practice, QOL improvement can be accelerated using combination of partial sleep deprivation with the sertraline therapy.     

Experience of the use of velaxin (venlafaxine) in anxious depression

Thirty patients (seven men and 23 women, mean age 35.3 ± 7.8 years) with anxious and anxious-apathic depression were studied. Of these, 24 patients were treated in hospital and six in out-patient clinics. Patients were treated for eight weeks with venlafaxine at doses of 225–375 mg/day. Mental state was assessed using a series of scales (CGI, HDRS, BDI, HADS-21). A total of 27 patients (90%) completed treatment. There were 25 (83.3%) responders on the CGI scale: “improvement” in mental state occurred in 16 (59.3%) of patients and “marked improvement” occurred in nine (33.3%). “Insignificant improvement” was seen in two cases (7.4%). Complete elimination of symptoms of depression occurred in 33.3% of cases. Velaxin was found to be safe at intermediate therapeutic doses and there were improvements in laboratory results characterizing patients' somatic status. Translated from Zhurnal Nevrologii i Psikhiatrii imeni S. S. Korsakova, Vol. 108, No. 3, pp. 24–28, March, 2008.