度洛西汀治疗老年抑郁症与广泛性焦虑障碍有效性及安全性meta分析

目的:系统评价度洛西汀与安慰剂比较治疗老年抑郁症及广泛性焦虑障碍的疗效及安全性。方法:计算机检索PubMed、CochraneLibrary、EMbase、中国期刊全文数据库、中文科技期刊全文数据库、万方数字化期刊全文数据库,检索日期截至2016年11月。纳入度洛西汀与安慰剂比较治疗老年抑郁症及广泛性焦虑障碍的随机对照试验,按照Cochrane Handbook 5.1.0的质量评价标准评价纳入研究的质量后,采用Rev Man5.3软件进行meta分析。结果:共纳入6个研究,4篇研究针对老年抑郁症患者,2篇研究针对老年广泛性焦虑障碍患者。Meta分析结果显示:(1)治疗后度洛西汀组与安慰剂组的HAM-D治疗前后变化差值差异有统计学意义(SMD=-0.39,95%CI:-0.65~-0.12);HAM-A治疗前后变化差值差异亦有统计学意义(SMD=-0.54,95%CI:-0.76~-0.33);治疗后两组抑郁及焦虑痊愈率差异也有统计学意义。(2)治疗结束度洛西汀组与安慰剂组在总退出率、因不良反应退出率及严重不良反应发生率上差异无统计学意义;而在恶心、疲倦、便秘、口干、腹泻、嗜睡、出汗等不良反应发生率上两组差异有统计学意义,度洛西汀组发生率更高。(3)治疗后度洛西汀组与安慰剂组生活质量量表评分变化差值差异有统计学意义,度洛西汀能提高患者生活质量。结论:度洛西汀能提高老年抑郁症及广泛性焦虑障碍患者的临床治愈率,降低抑郁及焦虑量表评分,提高患者的生活质量,但增加恶心、疲倦、便秘、口干、腹泻、嗜睡、出汗等不良反应发生。     

盐酸度洛西汀治疗抑郁症的临床研究

目的探讨盐酸度洛西汀治疗抑郁症的临床疗效。方法采用开放性、前瞻性方法,对36例抑郁症患者进行盐酸度洛西汀治疗,用HAMD总分以及各因子分全面评定疗效。结果治疗前后患者HAMD总分、焦虑/躯体化、睡眠障碍、阻滞因子分有明显的下降,差异有显著性。结论盐酸度洛西汀治疗抑郁症起效快,副反应小,安全性高,值得临床应用。     

度洛西汀治疗抑郁伴焦虑障碍患者的随机双盲对照研究

目的比较度洛西汀与帕罗西汀治疗抑郁伴焦虑障碍的疗效和安全性。方法对24例符合CCMD-3抑郁发作和广泛性焦虑诊断标准的患者随机双盲进入度洛西汀或帕罗西汀组治疗6周,分别在治疗前及第1、2、4、6周末进行汉密尔顿抑郁量表17项（HAMD）、汉密尔顿焦虑量表（HAMA）和临床疗效总评量表的病情严重程度（CGI-SI）评定,进行体格检查、实验室检查,及采用副反应量表（TESS）评估用药安全性。结果经6周治疗后显示,度洛西汀总体疗效比帕罗西汀稍好且起效快,效果良好,在治疗第1周末HAMD总分与帕罗西汀组有显著性差异（P〈0.05）。两组不良反应均较轻微。结论度洛西汀抗抑郁及抗焦虑作用确切,可用于治疗抑郁症伴焦虑障碍。     

度洛西汀联合米氮平治疗难治性广泛性焦虑障碍的临床研究

目的探讨度洛西汀联合米氮平治疗难治性广泛性焦虑障碍的疗效和安全性。方法 57例难治性广泛性焦虑症患者随机分为3组,分别给予度洛西汀或米氮平或两药联合治疗6周,并采用《汉密尔顿焦虑量表》(HAMA)和《副反应量表》(TESS)评价疗效和安全性。结果治疗后各时点《HAMA》评分联合组均低于度洛西汀组及米氮平组,且有统计学意义(P值均<0.05)。3组不良反应均较轻,且容易耐受。结论度洛西汀联合米氮平治疗难治性广泛性焦虑障碍的疗效较好,且安全有效。     

盐酸度洛西汀肠溶胶囊治疗抑郁症的疗效及安全性分析

目的 针对盐酸度洛西汀肠溶胶囊治疗抑郁症的疗效及安全性展开分析。方法 50例抑郁症患者作为研究对象,随机分为对照组和实验组,每组25例。对照组患者给予阿米替林片进行治疗,实验组患者予以盐酸度洛西汀肠溶胶囊进行治疗。比较两组患者不良反应发生情况、不同时间段汉密顿抑郁量表(HAMD)评分及治疗效果。结果 实验组患者的不良反应发生率为4%,低于对照组的24%,差异具有统计学意义(P<0.05)。实验组治疗第2、4周的HAMD评分均低于对照组,差异具有统计学意义(P<0.05)。实验组患者的治疗总有效率76%略高于对照组的52%,但差异无统计学意义(P>0.05)。结论 实施盐酸度洛西汀肠溶胶囊治疗抑郁症的疗效与经典三环类抗抑郁药阿米替林片相当,但盐酸度洛西汀肠溶胶囊的不良反应发生率更低,具有应用及推广价值。     

度洛西汀联合坦度螺酮治疗男性抑郁症伴焦虑患者的疗效及不良反应观察

目的 探究男性抑郁症伴焦虑患者采用度洛西汀联合坦度螺酮的治疗效果及不良反应。方法 选取抑郁症伴焦虑男性患者60例,随机分为对照组和观察组,各30例。对照组单纯采用度洛西汀治疗,观察组在对照组基础上联合坦度螺酮治疗,观察两组患者治疗效果、抑郁程度、焦虑程度及不良反应情况。结果 观察组治疗总有效率高于对照组(P<0.05);治疗后观察组HAMD、HAMA评分明显低于对照组(P<0.05);两组不良反应发生率对比差异无统计学意义(P>0.05)。结论 度洛西汀联合坦度螺酮对男性抑郁症伴焦虑患者效果显著,明显降低患者抑郁、焦虑评分,不良反应较少,值得临床应用及推广。     

度洛西汀与帕罗西汀治疗抑郁症的对照研究

目的探讨度洛西汀与帕罗西汀治疗抑郁症的疗效及安全性。方法68例抑郁症患者随机分度洛西汀组（n=33）及帕罗西汀组（n=35）治疗8周。以汉密尔顿抑郁量表（HAMD-17）、汉密尔顿焦虑量表（HAMA）和治疗中出现的症状量表（TESS）评定疗效及不良反应。结果治疗后2组HAMD、HAMA总分均较治疗前显著下降（P〈0．01）。度洛西汀组患者的有效率为93．9％,帕罗西汀组为94．3％,均有显著疗效,2组比较差异无统计学意义（P〉0．05）。HAMD评分度洛西汀组在治疗第1、2周末较帕罗西汀组减分明显（P〈0．05）。结论度洛西汀是一种安全、有效的抗抑郁药,值得临床推广应用。     

新闻视窗

FDA批准度洛西汀治疗广泛性焦虑症2007年2月,礼来公司(EliLilly)宣布FDA已经批准其抗抑郁药度洛西汀(duloxetine,Cymbalta)用于治疗广泛性焦虑症(GAD)。本品为5-羟色胺和去甲肾上腺素再摄取抑制剂,此前已获准用于治疗成人抑郁障碍和糖尿病性外周神经性疼痛。     

度洛西汀联合艾司西酞普兰对女性抑郁症患者焦虑抑郁状态、睡眠质量及不良反应的影响

目的:探讨度洛西汀联合艾司西酞普兰对女性抑郁症患者焦虑抑郁状态、睡眠质量及不良反应的影响。方法:应用临床医学研究对比法,随机抽取我院2018年8月-2019年2月间收治的女性抑郁症患者72例,依照治疗药物应用不同,等分为观察组和对照组,给予对照组度洛西汀单独药物治疗,给予观察组联合艾司西酞普兰治疗,临床观察预后对女性抑郁症患者焦虑抑郁状态、睡眠质量及不良反应的影响。结果:观察组不良反应5.56%(2/36)明显低于对照组不良反应19.44%(7/36),有统计学意义P0.05;观察组焦虑状态评分和抑郁状态评分明显低于对照组,睡眠质量改善效果明显高于对照组,有统计学意义P0.05。结论:度洛西汀联合艾司西酞普兰对女性抑郁症患者联合治疗临床疗效确切,比之单独应用度洛西汀治疗效果明显,能有效降低女性抑郁症患者焦虑抑郁状态和不良反应,改善患者睡眠质量,整体提升预后效果,值得临床推广实施。     

度洛西汀治疗慢性阻塞性肺疾病合并抑郁焦虑障碍28例疗效观察

目的观察度洛西汀治疗慢性阻塞性肺疾病合并抑郁焦虑障碍的临床效果。方法选取2009年10月～2011年10月本院收治的56例慢性阻塞性肺疾病合并抑郁焦虑障碍为研究对象,将其随机地分为对照组和度洛西汀组,对照组给予常规治疗,度洛西汀组在常规治疗的基础上加服度洛西汀治疗,连续治疗4周后检测两组患者各项指标,同时采用圣乔治呼吸问卷及TESS副反应量表的形式评价记录两组患者的生活质量和药物不良反应。结果与对照组相比,度洛西汀组患者生活质量显著提高,药物不良反应较低,且患者焦虑和抑郁评分明显降低,两组对比差异具有统计学意义（P〈0.05）。结论度洛西汀能有效治疗慢性阻塞性肺疾病,提高患者生活质量,改善患者抑郁焦虑等不良情绪,因此,值得临床推广和应用。     

Paroxetine treatment of generalized anxiety disorder

Generalized anxiety disorder (GAD) is a prevalent and disabling anxiety disorder, conservatively believed to affect at least 5% of the general population. Cardinal symptoms of GAD include chronic and uncontrollable worry, anxiety, and tension, which result in difficulty fulfilling social, professional, and family roles. Treatment options include benzodiazepines, tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and the serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine XR. Because of the high comorbidity of GAD with other psychiatric disorders, pharmacologic therapy should possess both anxiolytic and antidepressive properties for best outcomes. The SSRIs are a good treatment option, and paroxetine is the best studied SSRI for GAD and the only SSRI to date approved by the US Food and Drug Administration for this indication. Results of randomized, controlled studies of paroxetine have demonstrated its efficacy in the short-term treatment of GAD, in achieving and sustaining full remission, and in preventing relapse. This article provides an overview of GAD and a discussion of studies of paroxetine treatment in this anxiety disorder.     

A psychopharmacological treatment algorithm for generalised anxiety disorder (GAD)

Generalised anxiety disorder (GAD) is defined as excessive and uncontrollable worry and anxiety about everyday life situations. It is a chronic disorder, and is associated with substantial somatisation, high rates of comorbid depression and other anxiety disorders, and significant disability. The evidence base for pharmacotherapy and psychotherapy has continued to grow, and a wide range of drug choices for GAD now exists. Current guidelines for GAD generally restrict themselves to presentation of the evidence for various treatments, which, as a result, generally do not offer detailed discussion or recommendation of strategies beyond the first level of treatment, or take into account the individual circumstances of the patient. Thus, there is a lack of algorithm-based treatment guidelines for GAD. Our aim is, therefore, to present an algorithm for the psychopharmacologic management of GAD, intended for all clinicians who treat patients with GAD, where issues of pharmacotherapy are under consideration. We also hope that these GAD algorithms and other guidelines can help to identify high-priority areas that need further study. In this algorithm, we provide a sequenced approach to the pharmacotherapy of GAD, taking into account salient symptomatology and comorbidity, levels of evidence and extent of response. Special issues, including comorbidity, insomnia, suicidality, substance abuse, treatment adherence, pregnancy and lactation, cross-cultural issues, use of medication in the elderly, psychosocial treatment and dosing issues are also addressed.     

广泛性焦虑患者治疗前后心率变异性对比研究

目的探讨广泛性焦虑(GAD)患者治疗前后自主神经系统的变化特点。方法选取80例GAD患者为研究组,40例健康成人为对照组,进行24hHRV时域和频域指标测定,并运用统计学软件进行分析比较。结果 GAD患者治疗前与正常对照组及治疗后比较,各项指标均存在差异(P<0.05),尤其rMSSD、PNN50、SDNN存在显著统计学意义(P<0.01);GAD患者治疗前组白天和夜间HRV各项指标无统计学意义(P均>0.05)。结论 GAD患者以迷走神经张力下降,交感神经张力相对亢进为主,HRV指标可作为监测GAD患者自主神经功能的一项量化评估指标。     

Paroxetine in the treatment of generalised anxiety disorder

Paroxetine is a selective serotonin re-uptake inhibitor useful in the treatment of a wide range of psychiatric disorders. Generalised anxiety disorder (GAD) is characterised by excessive persistent anxiety and worry about a number of events and activities occurring on more days than not for at least 6 months. GAD is the most common anxiety disorder in primary care settings. Paroxetine was the second antidepressant to receive an FDA indication for the treatment of GAD. In contrast to benzodiazepines, which had been the mainstay of treatment for anxiety disorders for many years, antidepressants, such as paroxetine, are more effective for the psychic symptoms of anxiety, which include worry, tension, irritability and concentration difficulties, and carry a more tolerable and safe side effect profile.     

Paroxetine in the treatment of generalised anxiety disorder

Paroxetine is a selective serotonin re-uptake inhibitor useful in the treatment of a wide range of psychiatric disorders. Generalised anxiety disorder (GAD) is characterised by excessive persistent anxiety and worry about a number of events and activities occurring on more days than not for at least 6 months. GAD is the most common anxiety disorder in primary care settings. Paroxetine was the second antidepressant to receive an FDA indication for the treatment of GAD. In contrast to benzodiazepines, which had been the mainstay of treatment for anxiety disorders for many years, antidepressants, such as paroxetine, are more effective for the psychic symptoms of anxiety, which include worry, tension, irritability and concentration difficulties, and carry a more tolerable and safe side effect profile.     

Pharmacological treatment of generalized anxiety disorder

INTRODUCTION: Generalized anxiety disorder (GAD) is a chronic, relapsing, debilitating disorder, associated with markedly impaired social and occupational functioning. Pharmacological treatment is considered standard care and several drug classes are now FDA approved for the treatment of GAD. While there are clear data for the efficacy of short-term acute treatment, long-term treatment and treatment-resistant GAD remain challenging. AREAS COVERED: This article describes current pharmacological treatment options for GAD, with focus on benzodiazepines, azapirones, antidepressants and anticonvulsant and antipsychotic drugs. Recent findings from placebo-controlled clinical trials are reviewed and evidence-based clinical implications are discussed. A PubMed search was completed using the terms: 'generalized anxiety disorder AND treatment' and 'generalized anxiety disorder AND therapy'. Additional pivotal trials were included for a historical perspective (older landmark trials that established efficacy and safety for older drug classes in the treatment of GAD). EXPERT OPINION: Efficacy for treatment of GAD has been established for several different drug classes. At present, based on clear efficacy and good tolerability, first-line treatment with either a selective serotonin reuptake inhibitor (SSRI) or a serotonin-norepinephrine reuptake inhibitor (SNRI) is indicated. If an initial, at least moderate, clinical response is achieved under antidepressant therapy, treatment should be at least continued for 12 months.     

Generalized anxiety disorder: raising the expectations of treatment

Anxiety disorders are prevalent and associated with an increase in morbidity and mortality, particularly when present with additional psychiatric disorders. They represent a public health and economic burden, yet they are commonly underrecognized and undertreated. Benzodiazepines are effective anxiolytics, but they primarily treat the somatic symptoms of generalized anxiety disorder (GAD), and are not effective in treating the depressive symptoms that are often comorbid in chronic anxiety disorders like GAD. Some antidepressants may therefore offer the best choice of therapy. Their benefit in the treatment of GAD has been demonstrated using the tricyclic antidepressant, imipramine, and some selective serotonin reuptake inhibitors. The serotonin and norepinephrine reuptake inhibitor venlafaxine extended release (XR), has been indicated for GAD and has proven to be effective in both the short- and long-term treatment of patients with this disorder. Many patients treated with venlafaxine XR achieve and sustain remission from the symptoms of GAD, which is the goal of treatment.     

Pharmacological treatment of generalized anxiety disorder

Introduction: Generalized anxiety disorder (GAD) is a chronic, relapsing, debilitating disorder, associated with markedly impaired social and occupational functioning. Pharmacological treatment is considered standard care and several drug classes are now FDA approved for the treatment of GAD. While there are clear data for the efficacy of short-term acute treatment, long-term treatment and treatment-resistant GAD remain challenging.

Areas covered: This article describes current pharmacological treatment options for GAD, with focus on benzodiazepines, azapirones, antidepressants and anticonvulsant and antipsychotic drugs. Recent findings from placebo-controlled clinical trials are reviewed and evidence-based clinical implications are discussed. A PubMed search was completed using the terms: ‘generalized anxiety disorder AND treatment’ and ‘generalized anxiety disorder AND therapy’. Additional pivotal trials were included for a historical perspective (older landmark trials that established efficacy and safety for older drug classes in the treatment of GAD).

Expert opinion: Efficacy for treatment of GAD has been established for several different drug classes. At present, based on clear efficacy and good tolerability, first-line treatment with either a selective serotonin reuptake inhibitor (SSRI) or a serotonin-norepinephrine reuptake inhibitor (SNRI) is indicated. If an initial, at least moderate, clinical response is achieved under antidepressant therapy, treatment should be at least continued for 12 months.     

帕罗西汀治疗对广泛性焦虑昼夜心率变异性的影响

目的探讨帕罗西汀治疗后广泛性焦虑患者心率变异性昼夜节律变化。方法 43例广泛性焦虑患者接受盐酸帕罗西汀治疗4周。分别于治疗前、治疗后进行24h动态心电图监测及心率变异性分析。结果治疗前日间与夜间SDNN、SDANN、rMSSD、PNN50比较,差异无统计学意义。治疗后日间与夜间比较,四个参数比较差异有统计学意义。结论帕罗西汀可以改善广泛性焦虑患者自主神经的昼夜节律性。     

Generalised anxiety disorder in elderly patients : epidemiology, diagnosis and treatment options

Generalised anxiety disorder (GAD) is characterised by at least 6 months of excessive uncontrollable worry accompanied by symptoms of motor tension and vigilance and scanning. As with other anxiety disorders, GAD is less prevalent in older adults than younger adults. GAD has a high level of comorbidity with other psychiatric disorders and this has a bearing on estimates of its prevalence. GAD that is comorbid with another psychiatric disorder has a period prevalence of approximately 4% in community-dwelling older people. On the other hand, 'pure' GAD is less common, with a period prevalence of approximately 1%. Pure GAD in late life is a fairly even mix of chronic cases that began earlier in life and cases starting for the first time in later life.The most frequent and consistent finding regarding late-life generalised anxiety is its high level of comorbidity with major depression. There are few longitudinal data pertaining to the temporal association of generalised anxiety and major depression in late life, but the data that do exist suggest that the anxiety is frequently symptomatic of the depression. If generalised anxiety occurs exclusively during episodes of major depression, a separate diagnosis of GAD is not warranted. Cognitive behaviour therapy (CBT) is the most frequently studied psychological treatment for GAD. Although CBT is more effective than a wait-list control condition, it is not more effective than nondirective therapies in late-life GAD. Furthermore, a standard course of CBT appears to be less efficacious for GAD in older adults than younger adults. Further research is needed to develop more efficacious and specific forms of psychotherapy for late-life GAD.The three classes of medications that are most commonly used for GAD are: (i) antidepressants; (ii) benzodiazepines; and (iii) buspirone. Antidepressant medication is the pharmacological treatment of choice for most older adults with generalised anxiety. When generalised anxiety is secondary to an episode of major depression, the selection of an antidepressant is guided by the same principles that apply to treatment of nonanxious depression. Antidepressant medication is also effective for GAD in the absence of an episode of major depression. In this situation, citalopram and venlafaxine have been found to be efficacious in older people. Data from studies of mixed-aged patients suggest that escitalopram, paroxetine and trazodone may also be beneficial in late-life GAD. Despite their widespread use in older persons with anxiety, benzodiazepines have a limited role in the treatment of GAD in the elderly. If a benzodiazepine is initiated, pharmacokinetic considerations favour the use of either lorazepam or oxazepam. Buspirone also has a more limited role than antidepressants in the treatment of late-life GAD.