盐酸氟西汀治疗强迫症临床开放性对照研究

为观察氟西汀对强迫症病人的疗效和不良反应,进行了开放性对照研究,对照药物为氯丙咪嗪。氟西汀组30例,氯丙咪嗪组30例,均符合CCMD-2-R有关强迫症的诊断标准。疗程8周,予临床疗效评定和Y-BOCS副反应量表评定。结果显示,氟西汀治疗强迫症显效率与氯丙咪嗪相近,见效时间4～6周,不良反应明显低于氯丙咪嗪,提示氟西汀对强迫症安全、有效。     

Fluoxetine for depression in diabetes: a randomized double-blind placebo-controlled trial

OBJECTIVE: Depression is prevalent in patients with diabetes. It is associated with poor glycemic control and is linked to an increased risk for diabetic complications. In this study, we assessed the efficacy of fluoxetine for depression in patients with diabetes. RESEARCH DESIGN AND METHODS: Sixty patients with diabetes (type 1, n = 26; type 2, n = 34) and major depressive disorder entered an 8-week randomized placebo-controlled double-blind trial. Patients were given daily doses of fluoxetine (up to 40 mg/day). The Beck Depression Inventory (BDI) and Hamilton Rating Scale for Depression (HAMD) were used to measure the severity of depression and to determine the percentage of patients who achieved substantial improvement or complete remission. GHb levels were obtained to monitor glycemic control. RESULTS: Reduction in depression symptoms was significantly greater in patients treated with fluoxetine compared with those receiving placebo (BDI, -14.0 vs. -8.8, P = 0.03; HAMD, -10.7 vs. -5.2, P = 0.01). The percentage of patients achieving a significant improvement in depression per the BDI was also higher in the fluoxetine group (66.7 vs. 37.0%, P = 0.03). Additionally, trends toward a greater rate of depression remission (48.1 vs. 25.9%, P = 0.09 per the HAMD) and greater reduction in GHb (-0.40 vs. -0.07%, P = 0.13) were observed in the fluoxetine group. CONCLUSIONS: Fluoxetine effectively reduces the severity of depression in diabetic patients. Our study demonstrated that after only 8 weeks, this treatment also produced a trend toward better glycemic control.     

氟西汀联合喹硫平对重症抑郁症患者的临床疗效观察

【目的】观察氟西汀合并喹硫平对重症抑郁的治疗效果。【方法】将97例重症抑郁症患者随机分为联合组和对照组,分别给予氟西汀联合喹硫平（联合组）以及氟西汀合并安慰剂（对照组）治疗。联合组48例,氟西汀平均治疗剂量为（27．08±11．29）mg／d,喹硫平治疗剂量均为200mg／d;对照组49例,氟西汀平均治疗剂量为（38．78±9．49）mg／d,疗程共6周。采用汉密尔顿抑郁量表（HAMD）和汉密尔顿焦虑量表（HA—MA）评定疗效,副反应量表（TESS）评定不良反应。量表评定于治疗前和治疗后第1、2、4、6周末分别进行。【结果】①两组治疗后第1、2、4、6周末的HAMD和HAMA评分分别与治疗前相比,差异非常显著（P〈0．01）。②联合组与对照组的显效率分别为85．4％和77．5％,差异无显著性（P〉0．05）;联合组的氟西汀剂量显著低于对照组。③TESS量袁评定两组各测定时点分值的差异无显著性（P〉0．05）。【结论】氟西汀合并喹硫平治疗重症抑郁起效快、效果好,可降低氟西汀剂量,是治疗重症抑郁较好的方法。     

A placebo-controlled comparison of the effects on sexual functioning of bupropion sustained release and fluoxetine

BACKGROUND: Many antidepressants are associated with sexual dysfunction, a side effect that may lead to patients' dissatisfaction and noncompliance with treatment. OBJECTIVE: This study compared the efficacy, tolerability, and effects on sexual functioning of bupropion sustained release (bupropion SR) and the selective serotonin reuptake inhibitor fluoxetine. METHODS: In this multicenter, randomized, double-blind, double-dummy, parallel-group study, patients with recurrent major depression were treated with bupropion SR 150 to 400 mg/d, fluoxetine 20 to 60 mg/d, or placebo for up to 8 weeks. Depression and sexual-functioning status were assessed by site-specific trained investigators at weekly clinic visits; tolerability was assessed primarily by monitoring adverse events. RESULTS: Four hundred fifty-six patients participated in the study, 150 receiving bupropion SR, 154 fluoxetine, and 152 placebo. The majority of patients in each group completed the study (63% each, bupropion SR [n = 94] and fluoxetine [n = 97]; 67%, placebo [n = 102]). Bupropion SR and fluoxetine were similarly effective in the treatment of depressive symptoms. Beginning at week 2 and continuing throughout the study, significantly more fluoxetine-treated patients experienced orgasm dysfunction than did patients receiving bupropion SR or placebo (P < 0.001); similar results were seen in patients defined as clinical responders (> or =50% decrease from baseline in 21-item Hamilton Rating Scale for Depression [HAM-D] total score) (P < 0.001) and in those experiencing remission of depression (HAM-D total score <8) (P < 0.05). At various time points, worsened sexual functioning, sexual desire disorder, sexual arousal disorder, and dissatisfaction with sexual functioning in those satistied at baseline were more frequently associated with fluoxetine treatment than with bupropion SR or placebo. Both active treatments were well tolerated. CONCLUSIONS: Bupropion SR and fluoxetine were similarly effective and well tolerated in the treatment of depression. Fluoxetine, however, was more frequently associated with sexual dysfunction compared with bupropion SR. Bupropion SR may be an appropriate initial choice for the treatment of depression in patients concerned about sexual functioning.     

艾司西酞普兰与氟西汀治疗抑郁症的临床疗效对比

目的探讨艾司西酞普兰与氟西汀治疗抑郁症的临床疗效。方法本研究按照随机数字表法将60例患者随机分为研究组和对照组各30例,其中研究组患者采用艾司西酞普兰治疗,而对照组则采用氟西汀治疗,比较两组患者的临床疗效、HAMD评分及不良反应。结果研究组患者治疗2w后即起效,且HAMD评分明显低于对照组,且差异具有统计学意义(P0.05)。研究组的总有效率明显高于对照组,且差异具有统计学意义(P0.05)。研究组的不良反应发生率(36.67%)与对照组(40.00%)比较无明显差异(P0.05)。结论艾司西酞普兰在治疗抑郁症方面,与氟西汀相比临床疗效佳,起效快,安全性好,值得临床推广使用。     

Double-blind comparison of fluoxetine and nortriptyline in the treatment of moderate to severe major depression

BACKGROUND: Depression is an international public health problem. Impairment in social and occupational functioning, increased comorbidity with other psychiatric and medical conditions, and an increased risk of mortality are a few of its consequences. Some psychiatrists have the impression that selective serotonin re-uptake inhibitors may not work as well as tricyclic anti-depressants in severe depression and/or melancholia. On the contrary, there is a general belief that selective serotonin re-uptake inhibitors are superior to the tricyclic anti-depressants in having fewer side-effects, particularly cardiovascular effects. The objective of this double-blind study was to compare the efficacy and safety of fluoxetine and nortriptyline in patients with moderate to severe major depression. METHODS: A total of 48 adult outpatients who met the Diagnostic and Statistical Manual of Mental Disorders (DSM IV), forth edition for major depression, based on the structured clinical interview for DSM IV participated in the trial. Patients had a baseline Hamilton Rating Scale for Depression score of at least 20. In this double-blind, single-center trial, patients were randomly assigned to receive nortriptyline 150 mg/day (group 1) or fluoxetine 60 mg/day (group 2) for 6-weeks. The outcome of the two groups was assessed using Hamilton Depression Rating Scale, a side-effect checklist and a regular ECG assessment. RESULTS: The results suggest that the efficacy of nortriptyline is superior to fluoxetine in this group of major depressed patients. No significant differences were observed between dropout rates in the two groups but anti-cholinergic side-effects were significantly more frequent with nortriptyline than with fluoxetine but there was no significant difference in cardiovascular effects in particular QTc prolongation. CONCLUSION: The results of the current study suggest that nortriptyline was more effective than fluoxetine in the treatment of moderate to severe depression. A larger study is warranted.     

氟西汀联合心理干预治疗心血管疾病伴焦虑抑郁的临床研究

目的：探讨氟西汀联合心理干预治疗心血管疾病患者伴焦虑抑郁症状的临床疗效。方法：选择伴有抑郁、焦虑情绪障碍的85例冠心病患者（心功能Ⅱ、Ⅲ级）,并将其随机分成研究组和对照组。观察6w,对照组患者仅给予常规的治疗,研究组患者在常规治疗基础上给予氟西汀联合心理干预治疗。观察治疗前后两组患者采用汉密顿焦虑量表（Hamilton Anxiety Scale,HAMA）评定焦虑症状,汉密顿抑郁量表（Hamilton Depression Scale,HAMD）评定抑郁症状;并对治疗后心功能分级（NYHA）恢复到Ⅰ级的例数及左室射血分数进行分析评价。结果：治疗6周后,研究组均较对照组的汉密顿焦虑量表及汉密顿抑郁量表评分下降显著（P〈0.01）,研究组抗焦虑显效率为87.16%、抗抑郁显效率为82.26%,对照组分别为43.75%、45.36%,研究组均显著高于对照组（P〈0.01）;研究组患者的左室射血分数显著高于对照组（P〈0.05）,心功能分级（NYHA）恢复到Ⅰ级的例数显著高于对照组（P〈0.05）。结论：氟西汀联合心理干预治疗不仅能改善心血管疾病伴焦虑抑郁患者的焦虑、抑郁情绪障碍,还能改善患者的心功能,疗效显著优于单用心血管药物治疗。     

氟西汀与氯丙咪嗪治疗强迫症的比较分析

目的　比较氟西汀与氯丙咪嗪治疗强迫症的疗效及不良反应。方法　将 6 6例患者随机分为两组 ,氟西汀组 34例 ,氯丙咪嗪组 32例 ,疗程 8w。采用强迫量表、汉密顿抑郁量表、汉密顿焦虑量表评定疗效 ,副反应量表评定副反应。结果　氟西汀组有效率 5 8.82 % ,氯丙咪嗪组有效率 5 9.38% ,两组比较差异无显著性 (P >0 .0 5 ) ;氯丙咪嗪组副反应较氟西汀组多。结论　氟西汀治疗强迫症疗效肯定 ,且副反应少而轻     

盐酸氟西汀和氯丙咪嗪对血管性抑郁症患者的治疗作用及其副反应比较

背景抑郁症患者中有很大一部分患有心脑血管疾病,将这组特殊的抑郁症称为血管性抑郁.5-羟色胺选择性抑制剂对抑郁症状的改善已有确切效果,对血管性抑郁患者是否具有同样的效果.目的观察盐酸氟西汀和氯丙咪嗪对血管性抑郁症患者抑郁程度改善的差异,以及两者副反应的特征.设计随机对照观察.单位新乡医学院第一附属医院心内科.对象2003-01/2004-12新乡医学院第一附属医院心内科连续门诊和住院患者.纳入标准①符合中国精神疾病分类与诊断标准中抑郁发作的诊断标准,并根据Alexopoulos等[1]的临床定义来确定血管性抑郁,即在抑郁症首次发病前或发病时即存在心、脑血管病的证据.②在抑郁症首次发病前或发病时即存在心脑血管病的证据CT或MRI有阳性病灶.③年龄在70岁以下.④患者及家属对本实验知情,并同意参与.排除标准①有药物过敏史.②有意识障碍及明显的痴呆症状者.③严重的心、肝、肾功能损害.④有严重精神障碍者.⑤有外伤、肿瘤、炎症或脱髓鞘等脑器质性病变者及既往有抑郁发作者.共收集符合上述标准患者60例,将患者随机分为治疗组和对照组,每组30例.方法两组患者在进行活血化瘀治疗的同时,治疗组口服盐酸氟西汀20 mg/d;对照组口服氯丙咪嗪,开始25 mg/次.根据病情和耐受情况增至50～250 mg/d,分3次服用;两组均治疗12周.采用汉密顿抑郁量表(24项,减分率＞50%为显效;≥25%为有效,＜25%为无效)对所有病例于治疗前、治疗后4,6和12周分别进行抑郁改善程度的评定,同时记录用药前后出现的不良反应和副作用.描述性资料以百分率表示,组间比较采用成组设计的x2检验,计量资料采用双侧t检验.主要观察指标主要结局①两组治疗前后汉密顿抑郁量表评分比较.②两组治疗后抑郁改善情况比较.次要结局两组不良事件和副反应发生情况.结果两组各30例患者完成治疗并参加疗效评估.①两组汉密顿抑郁量表评分结果比较治疗组治疗后6周和12周均低于治疗前(12.40±4.30,7.80±4.36和21.30±2.64;P＜0.01);也低于同时点对照组(6周13.20±4.90;12周7.90±4.20;t=3.98,5.02,P均＜0.01).②两组抑郁改善结果比较治疗组6周和12周有效率均高于对照组(6周93%和87%,12周97%和93%,P＞0.05).③两组不良事件和副反应发生情况比较治疗组为8例,其中可能与药物有关的有2例,主要有恶心、口干;对照组为13例,其中可能与药物有关的有10例,主要为口干、便秘、排尿困难,头昏、兴奋、激动.治疗组的发生率低于对照组(27%和43%,P＜0.01).结论盐酸氟西汀和氯丙咪嗪改善血管性抑郁患者抑郁症状的疗效相近;患者对盐酸氟西汀的耐受性好于氯丙咪嗪.     

Efficacy and tolerability of sustained-release clomipramine (Anafranil SR) in the treatment of phobias: a comparison with the conventional formulation of clomipramine (Anafranil)

This multicentre double-blind trial in general practice compared the efficacy and tolerability of the sustained-release formulation of clomipramine (Anafranil SR) with its conventional formulation (Anafranil) in the treatment of phobias. Patients were allocated at random to receive clomipramine 75 mg once daily as either the sustained-release or conventional formulation for 11 weeks following a 1-week dosage build-up period. Analysis of results from forty-six patients showed that the sustained release formulation of clomipramine 75 mg was as effective as the conventional formulation of clomipramine 75 mg in improving symptoms of phobia as assessed by a phobia inventory and global evaluation. Unwanted effects attributable to therapy were similar in both treatment groups but there were fewer withdrawals due to unwanted effects of the sustained release formulation of clomipramine 75 mg. It was concluded that the sustained-release formulation of clomipramine does offer advantages for patients requiring 75 mg clomipramine daily.     

不同剂量氟西汀治疗首发抑郁症临床研究

目的探讨不同剂量氟西汀治疗首发抑郁症的疗效及不良反应。方法将63例首发抑郁症患者随机分为A(18例)、B(28例)、C(17例)三组,分别给予氟西汀60mg·d-1、40mg·d-1和20mg·d-1治疗,疗程8w。采用汉密尔顿抑郁量表、副反应量表于治疗前及治疗2、4、6、8w末评定临床疗效和不良反应。结果三组汉密尔顿抑郁量表评分在治疗第2w末较治疗前显著下降;A、B组与C组在治疗第2w、4w末比较差异均有极显著性(P<0.01),A、B组显效较C组快。副反应量表评分在治疗第2w、4w末A组与B、C组同期比较差异有显著性(P均<0.05)。结论氟西汀治疗首发抑郁症的最有效剂量为40mg·d-1。     

盐酸氟西汀、匹维溴铵联合小剂量阿米替林治疗肠易激综合征疗效观察

目的研究盐酸氟西汀、阿米替林、匹维溴铵联合用药治疗肠易激综合征的临床疗效。方法82例符合罗马Ⅲ诊断标准并伴有焦虑和抑郁状态的肠易激综合征患者随机分为治疗组（n=43）和对照组（n=39）。两组均根据患者不同症状进行对症处理。治疗组口服盐酸氟西汀胶囊20 mg qd（早餐时顿服）,阿米替林6.25 mg qn,匹维溴铵片100mg tid,疗程8周。对照组仅予对症处理。应用症状变化评定疗效标准及汉密尔顿抑郁量表（（HAMD,17项）于治疗前及治疗8周后进行疗效评定。结果治疗后肠易激综合征症状缓解总有效率,治疗组为90.7%（39/43）,对照组为53.8%（21/39）,治疗组明显优于对照组（P〈0.05）;治疗8周后的HAMD总分,治疗组显著低于对照组（6.27±1.54 vs 15.04±5.86,P〈0.05）。两组治疗中、治疗后血常规、肝肾功能、电解质及心电图检查均无异常变化。结论盐酸氟西汀、阿米替林、匹维溴铵联合治疗肠易激综合征疗效确切。     

光照结合氟西汀治疗冬季发作抑郁症

目的观察光照结合氟西汀治疗冬季发作抑郁症的疗效。方法将 68例冬季发作的抑郁症患者随机分为治疗组和对照组各 3 4例。治疗组除接受氟西汀 (2 0mg/d)治疗外 ,还接受光照疗法 ,而对照组则单用氟西汀治疗。采用Beck抑郁自评量表(BDI)、汉密顿抑郁量表 (HAMD)对两组患者治疗前、治疗 2周、4周、8周 (治疗结束 )时的疗效进行评定 ;应用SCL 90量表在治疗前、治疗结束、随访 6个月时进行评定。结果治疗组患者的疗效优于对照组 (P <0 .0 5 )。结论光照结合氟西汀疗法对冬季发作的抑郁症有较好的近、远期疗效和预防复发作用。     

Efficacy of fluoxetine in Austrian patients with obsessive-compulsive disorder.

In an 8-week double-blind placebo-controlled trial we studied the efficacy of fluoxetine (FLX) in 53 Austrian patients with obsessive compulsive disorder (OCD) diagnosed according to DSM-III-R. The dosage of FLX was fixed at either 20, 40, or 60 mg per day. Response was prospectively defined as an at least 25% reduction on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and an improvement on Clinical Global Impression (CGI) rating to at least "much improved" at the endpoint. Patients treated with at least 40 mg FLX per day showed significantly higher response rates than did those receiving either placebo or FLX 20 mg/day. Compulsions were more reduced than obsessions and we also observed a strong placebo effect which is largely attributable to an improvement in the Y-BOCS compulsion subscore.     

盐酸氟西汀联合逍遥丸治疗孕中期引产产妇产后抑郁的疗效

【目的】探讨盐酸氟西汀联合逍遥丸治疗孕中期引产产妇产后抑郁的疗效。【方法】52例孕中期引产产后抑郁症产妇,随机分为对照组和观察组,每组26例,对照组产妇仅服用盐酸氟西汀,观察组产妇服用盐酸氟西汀和逍遥丸,均治疗4周,参照汉密尔顿抑郁量表（HDM A）和副作用量表（T ESS）评定两种治疗方法的疗效和副作用。【结果】观察组总有效率为96．15％,高于对照组（92．31％）,但差异无统计学意义（P＞0．05）,观察组患者痊愈率显著高于对照组（P＜0．05）;两组治疗后随着治疗时间的延长,HDMA 减分率均明显递增（P＜0．05）;治疗后第1周、第2周观察组TESS得分（6．87±2．38,6．06±2．71）明显小于对照组（9．12±3．03,8．01±2．97）（P＜0．05）。【结论】逍遥丸的配合治疗在一定程度上可提高盐酸氟西汀治疗产后抑郁疗效而减弱其副作用。     

艾司西酞普兰与帕罗西汀治疗抑郁症的对照研究

目的探讨艾司西酞普兰和帕罗西汀治疗抑郁症的疗效及安全性。方法将76例抑郁症患者随机分为艾司西酞普兰组(38例,10～20 mg/d)和帕罗西汀组(38例,20～40 mg/d),疗程各8周。分别采用汉密尔顿抑郁量表17项、临床整体量表-疗效总评估量表评定疗效,不良反应症状量表评定不良反应。结果两组疗效相当(P>0.05),但艾司西酞普兰组起效更快,不良反应更少(P<0.05)。结论艾司西酞普兰是一种理想的抗抑郁药。     

综合心理治疗对首发青少年抑郁症临床疗效的对照研究

目的探讨综合心理治疗对首发青少年抑郁症的临床疗效。方法将147例首发青少年抑郁症患者随机分为A组40例、B组37例、C组37例、D组33例;A组顿服盐酸氟西汀治疗,B组给予综合心理治疗;C组给予认知行为治疗,D组顿服盐酸氟西汀胶囊联合综合性心理治疗。观察8周。于治疗前及治疗第2周、4周、8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。结果四组患者治疗2周末起,汉密顿抑郁量表总分均较治疗前有显著下降（P〈0．01）;A组治疗第4周、8周末汉密顿抑郁量表总分减分率显著低于D组（P〈0．05或0．01）;B组治疗第2周、4周末总分减分率显著高于C组（P〈0．01）。治疗8周末,4组痊愈率、显效率均无显著性差异（P〉0．05）。结论对首发青少年抑郁症患者而言,综合心理治疗优于认知行为治疗,应用盐酸氟西汀联合综合心理治疗起效更快,效果更为显著。     

Ketorolac, a new non-opioid analgesic: a double-blind trial versus pentazocine in cancer pain

A randomized double-blind trial was performed to evaluate the efficacy of a new non-steroidal anti-inflammatory analgesic drug, ketorolac, in the treatment of cancer pain compared with the opioid pentazocine. A total of 40 patients with moderate to severe cancer pain were studied, 20 patients being treated with 10 mg ketorolac given orally every 6 h and 20 receiving 50 mg pentazocine given orally every 6 h for up to 7 days. A reduction in the severity of the pain was recorded in both treatment groups with no significant difference in efficacy being found between the two therapies, although withdrawals due to adverse reactions were significantly less in the ketorolac-treated group (p less than 0.005). It is concluded that ketorolac may be a useful and more acceptable alternative to opioids in the treatment of cancer pain.     

帕罗西汀与氟西汀治疗抑郁症的疗效比较

目的：评价国产帕罗西汀与氟西汀治疗抑郁症的临床效果和安全性。方法：将60例抑郁症病人随机分为两组：A组和B组．每组30例。A组采用国产帕罗西汀治疗；B组采用氟西汀治疗。两组均治疗6周。两组采用汉密尔顿抑郁量表（HAMD）评定疗效；用副反应量襄（TESS）评定副反应。结果：A组总有效率为76．7％，B组总有效率为80．0％，两组比较。差异无统计学意义（P〉0．05）；两组治疗后HAMD评分均有明显下降（P均〈0．01）。结论：国产帕罗西汀与氟西汀治疗抑郁症疗效相当，且安全。     

Intravenous maprotiline in severe and resistant primary depression: a double-blind comparison with clomipramine

A double-blind, randomized trial is described which was designed to compare the clinical effect of 100 mg daily of maprotiline (Ludiomil) and of clomipramine (Anafranil) given by the intravenous route in forty hospitalized female patients with severe and resistant primary depression. Physicians' assessment of patients' progress was made following 5, 9 and 21 days of treatment. The response rates to maprotiline and clomipramine were not significantly different even if a greater number of patients responded to clomipramine. None of the demographic and clinical variables considered could be identified as factor predicting the response to maprotiline and to clomipramine, even if a trend for a preferential responsiveness to clomipramine in the older patients was observed.