优克胶囊与阿米替林长期治疗抑郁症的效果一成本分析

目的 评价优克胶囊与阿米替林长期治疗抑郁症的疗效及成本一效果比。方法采用HAMD和TESS，对47例服用优克胶囊的抑郁患者和42例服用阿米替林的抑郁患者的疗效和副反应进行比较，并对其费用进行比较分析。结果优克胶囊和阿米替林治疗抑郁症的疗效和费用间无显著差异，但两者副反应有显著差异。结论优克胶囊费用和疗效与阿米替林相当，但更安全，适合用于长期治疗抑郁症。     

万拉法新、阿米替林、氟西汀治疗抑郁症的对照研究

目的　比较万拉法新、阿米替林和氟西汀治疗门诊抑郁症的疗效和副反应。方法　对符合CCMD Ⅲ抑郁发作诊断标准的患者随机分为三组 ,分别给以万拉法新、阿米替林及氟西汀治疗 ,治疗疗程为 6周 ,用Hamilton抑郁量表 (HAMD) ,临床大体印象量表 (CGI)、副反应量表 (TESS)进行评分。结果　治疗 6周后的显效率万拉法新组为 75 % ,阿米替林组为 70 % ,氟西汀组为 6 5 % ,差异无显著统计学意义 (χ2 =0 .4 2　P >0 .0 5 )。万拉法新组显效快 ,2周内的HAMD总分低于阿米替林和氟西汀组 ,差异有显著统计学意义 (F =5 .2 4　P <0 .0 1)。阿米替林组的副反应明显多于万拉法新和氟西汀组。结论　万拉法新是一种疗效较好而副反应较少的抗抑郁药。     

氟西汀与阿米替林治疗老年抑郁症的疗效比较

目的：探讨氟西汀对老年抑郁症的临床疗效及副反应。方法：对80例老年抑郁症病人的随机分为氟西汀组（40例）和阿米替林组（40例）进行治疗研究，采用HAMD，TESS量表分别评定疗效及副反应。结果：氟西汀与阿米替林对老年抑郁症的疗效相似，氟西汀副反应较阿米替林少而轻微，结论：氟西汀较适合于老年抑郁症的治疗，患者有较好的依从性。     

Effect of dietary phenylalanine on the plasma concentrations of phenylalanine, phenylethylamine and phenylacetic acid in healthy volunteers

1. Phenylethylamine has been proposed as a neuromodulator in several psychiatric and other brain disorders, and its concentration and that of its major metabolite, phenylacetic acid, in plasma may prove useful as state or trait markers in diagnosis, treatment or in the elucidation of biochemical mechanisms of these disorders. 2. The effect of dietary phenylalanine intake and changes in dietary phenylalanine intake on the plasma concentrations and changes in plasma concentrations, respectively, of phenylalanine, phenylethylamine and unconjugated and conjugated phenylacetic acid have been investigated. 3. Dietary phenylalanine affects the concentration of plasma phenylalanine on the following day, but has no effect on phenylethylamine or phenylacetic acid concentrations. Thus single measurements per subject of phenylethylamine or phenylacetic acid do not need to take dietary factors into account. 4. Changes in dietary phenylalanine (whether in absolute amount or in the proportion of phenylalanine in the diet) are significantly correlated with changes in unconjugated phenylacetic acid. Therefore, in longitudinal studies, dietary factors should be taken into account.     

Cost-effectiveness of mirtazapine compared to amitriptyline and fluoxetine in the treatment of moderate and severe depression in austria.

This study estimated the cost-effectiveness of mirtazapine, compared to amitriptyline and fluoxetine, in the management of moderate and severe depression in Austria, as well as the costs related to the discontinuation of antidepressant treatment from the perspective of the Austrian Sick Funds (Gebietskrankenkassen). The economic analyses were based on a meta-analysis of four randomised clinical trials comparing mirtazapine with amitriptyline, and on a six week comparative trial of mirtazapine and fluoxetine which was extrapolated to six months using assumptions derived from the literature. Decision models of the treatment paths and associated resource use attributable to managing moderate and severe depression in Austria were developed from clinical trial data, information on Austrian clinical practice obtained from interviews with an Austrian Delphi panel (comprising psychiatrists and GPs), and from published literature. The models were used to estimate the expected costs to the Gebietskrankenkassen of managing a patient with moderate or severe depression, and the indirect cost per patient to Austrian society due to lost productivity. The expected cost to the Gebietskrankenkassen of healthcare resource use attributable to managing a patient suffering from moderate or severe depression who discontinues antidepressant treatment was estimated to be ATS 4,088 over five months, of which hospitalisations accounted for nearly 69% of the cost. Using mirtazapine instead of amitriptyline for 28 weeks increases the proportion of successfully treated patients by 21% (from 19.2 to 23.2%), and reduces the expected cost to the Gebietskrankenkassen by ATS 1,112 per patient (from ATS 31,411 to ATS 30,299). Patients treated with mirtazapine and amitriptyline for 28 weeks are expected to miss 4.76 and 5.01 weeks of work respectively, due to their depression. Hence, the expected indirect cost to Austrian society over this period was estimated to be ATS 58, 787 and ATS 61,851 per patient respectively. Using mirtazapine instead of fluoxetine for six months increases the proportion of successfully treated patients by 22% (from 15.6 to 19.1%), albeit for a negligible additional cost to the Gebietskrankenkassen of ATS 408 per patient (from ATS 29,205 to ATS 29,613). Patients treated with mirtazapine and fluoxetine for six months are expected to miss 4.53 weeks of work, due to their depression. Hence, the expected indirect cost to Austrian society due to lost productivity was estimated to be ATS 55,900 per patient with either antidepressant. In conclusion, this study suggests that despite the differences in acquisition costs, mirtazapine is a cost-effective antidepressant compared to amitriptyline and fluoxetine, supporting the adoption of this treatment in the management of moderate and severe depression in Austria.     

西酞普兰与氟西汀治疗脑卒中后抑郁疗效观察

目的 探讨西酞普兰与氟西汀治疗脑卒中后抑郁的临床疗效及安全性.方法 将68例脑卒中后抑郁患者随机分为2组各34例,2组均给予神经内科常规及康复治疗,在此基础上治疗组口服西酞普兰,对照组口服氟西汀治疗.均观察8周.于治疗前及治疗后第2、4、6、8周末采用汉密顿抑郁量表(HAMD)及副反应量表(TESS)评定临床疗效和不良反应.结果 治疗8周末,治疗组总有效率为94.1%,对照组为76.5%,2组疗效比较有显著性差异(P<0.05).2组治疗后HAMD评分均较治疗前有显著下降(P<0.01),随着治疗时间的延续均呈持续性下降.同期2组间HAMD评分比较均无显著性差异(P>0.05).2组不良反应均较轻微.结论 西酞普兰治疗脑卒中后抑郁疗效好,不良反应少,安全性高,依从性好.     

Urinary phenylacetic acid in panic disorder with and without depression

Phenylacetic acid (PAA) excretion was measured in 39 patients who met criteria for panic disorder; 9 of these also had major depression, and 30 did not. Patients with panic and depression excreted 66 +/- 23 mg/day of PAA, an amount significantly lower than in normal controls; patients with panic disorder but without depression excreted 104 +/- 23 mg/day of PAA (not significantly lower than controls). The results support previous studies indicating that PAA excretion is a marker for depressive disorder.     

氟西汀与阿米替林维持性治疗抑郁症的疗效比较

目的　为观察氟西汀对抑郁症病人维持性治疗的疗效和不良反应。方法　本文对象是在急性发作期中单独用氟西汀或阿米替林治疗 2～ 3个月 ,当其症状显著好转 (即汉密顿抑郁量表减分率 >5 0 % )后的抑郁症 96例 ,并分为两组 (氟西汀组 46例、阿米替林组 5 0例 ) ,再经 12个月的维持性治疗后 ,采用汉密顿抑郁量表和副反应量表评定疗效和不良反应。结果　氟西汀维持性治疗的总有效率 ( 90 2 % )与阿米替林 ( 93 0 % )相近 ,而前者的不良反应发生率 ( 4 6 3 % )明显低于后者 ( 81 4% )。结论　氟西汀对维持性治疗抑郁症有效、安全 ,是维持治疗的理想药物     

Early fluoxetine treatment of post-stroke depression

Objective: Poststroke depression is a frequent psychiatric complication after stroke that may have strong negative impact on rehabilitation therapy and functional recovery. This study was conducted to show the efficacy and safety of early treatment with the selective serotonin reuptake inhibitor fluoxetine in post-stroke depressed patients. Methods: This double-blind, randomized placebo-controlled study was of patients within two weeks after stroke. Moderate to severe depressed patients (determined by Hamilton Depression Scale (HDS) > 15, the Beck Depression Inventory (BDI) and the Clinical Global Impression (CGI) Scale) were randomized to receive either 20 mg/d fluoxetine or placebo for 3 months. Beside the psychiatric assessment, patients were evaluated by use of the Scandinavian Stroke Scale (SSS), the Mini-Mental-State-Examination (MMSE) and the Barthel-Index (BI). An open-label long-term follow up was done 18 months after the initial assessment. Results: 54 depressed patients of an inpatient population of 242 consecutive stroke patients aged 25 to 85 years entered the trial within the first two weeks post-stroke. 50 patients completed the trial per-protocol. The initial severity of depression was comparable in the two groups (mean baseline HDS score 32.8 in the fluoxetine vs. 30.3 in the placebo group), as were neurological symptom severity and demographic parameters. Significant improvement was seen in both groups within 4 weeks of treatment, whereas no advantages of fluoxetine could be observed at this time. This indicates a high degree of spontaneous recovery during early rehabilitation therapy. BDI scores of patients treated with fluoxetine further decreased until the follow-up at 12 weeks, whereas the scores increased again in the placebo group. This depressive relapse of the placebo patients after the end of most rehabilitation efforts was evident at a long-term follow-up 18 months after inclusion, when patients who had been treated with fluoxetine were significantly less depressed. No side effects of fluoxetine treatment were detected. Conclusions: The advantages of fluoxetine were obvious at the follow-up 18 months after inclusion, but could not be demonstrated within the first three months of controlled treatment. The multitude of therapeutic efforts that take place in the early phase of rehabilitation might have facilitated spontaneous recovery from depression and might have hindered benefits of antidepressant treatment to become obvious. Fluoxetine treatment was well tolerated and safe. Received: 5 February 2002, Received in revised form: 8 October 2002, Accepted: 28 October 2002 Correspondence to Stefan Fruehwald, MD     

氟西汀与阿米替林治疗躯体形式障碍的对照研究

目的 探讨氟西汀对躯体形式障碍的临床疗效及副反应。方法 采用随机分组的方法，将符合CCMD-3标准的63例躯体形式障碍患者分为氟西汀组(33)例、阿米替林组(30)例，治疗6周，用HAMD和TESS评定两组药的疗效及副反应。结果 氟西汀与阿米替林疗效相当，但在副反应方面差异有显著性，氟西汀副反应轻微。结论 氟西汀治疗躯体形式障碍安全、有效，值得临床应用。     

Economic impact of using mirtazapine compared to amitriptyline and fluoxetine in the treatment of moderate and severe depression in the UK.

This study modelled the economic impact of mirtazapine, compared to amitriptyline and fluoxetine, in the management of moderate and severe depression in the UK, as well as the costs related to discontinuation of antidepressant treatment. Decision models of the management of moderate and severe depression were developed from clinical trial data, resource use obtained from interviews with general practitioners and psychiatrists, and published literature, and were used to estimate the expected direct National Health Service (NHS) costs of managing a patient with moderate or severe depression. The expected cost of healthcare resource use attributable to managing a patient suffering from moderate or severe depression who discontinues antidepressant treatment, irrespective of the initial treatment, was estimated to be pounds sterling 206 (range pounds sterling 50 to pounds sterling 504) over five months. Using mirtazapine instead of amitriptyline for seven months increases the proportion of successfully treated patients by 21% (from 19.2 to 23.2%) and reduces the expected direct NHS cost by pounds sterling 35 per patient (from pounds sterling 448 to pounds sterling 413). Using mirtazapine instead of fluoxetine for six months increases the proportion of successfully treated patients by 22% (from 15.6 to 19.1%), albeit for an additional cost to the NHS of pounds sterling 27 per patient (from pounds sterling 394 to pounds sterling 420). In conclusion, this study suggests that mirtazapine is a cost-effective antidepressant compared to amitriptyline and fluoxetine in the management of moderate and severe depression in the UK.     

丁螺环酮联合氟西汀治疗抑郁症的疗效分析

目的探讨丁螺环酮联合氟西汀治疗抑郁症的临床疗效。方法选取本院2014年1月至2017年6月符合ICD-10抑郁症诊断标准的186例抑郁症患者,按不同治疗方案随机分成对照组和观察组2组:对照组为氟西汀+安慰剂组(n=93),观察组为氟西汀+丁螺环酮组(n=93),疗程8w。通过Hamilton抑郁量表(HAMD-17项)和不良反应症状量表(TESS)观察治疗前、及治疗后2、4、6、8w 2组患者的临床治疗效果与不良反应。结果 2组患者在治疗前和治疗2w后的HAMD-17项评分相比差异无统计学意义(P0.05),然而从第4周开始,2组HAMD-17项评分相比差异有统计学意义(P0.05)。观察组患者痊愈率(30.11%vs 16.13%,χ~2=5.112,P=0.024)和总有效率(88.17%vs 73.12%,χ~2=6.751,P=0.009)均显著高于对照组患者。从第4周开始,2组患者TESS评分相比(P0.05)。观察组患者与对照组相比失眠发生率显著降低(12.90%vs 24.73%,χ~2=4.258,P=0.039)。结论丁螺环酮可增强氟西汀治疗抑郁症的疗效,同时对改善抑郁症睡眠障碍有显著作用。     

5-HT1A receptor function in depression: effect of chronic amitriptyline treatment

Summary Hypothermic responses to 5-HT_1A receptor activation by the selective ligand ipsapirone (IPS) were attenuated in depressed patients as compared to controls. Chronic treatment with amitriptyline (AMI) further impaired 5-HT_1Amediated hypothermia. The results indicate a subsensitive (presynaptic) 5-HT_1A receptor and/or a defective post-receptor signalling pathway in depression and are consistent with the hypothesis that 5-HT_1A receptors are down-regulted during AMI treatment.     

苯乙酸对大鼠原代皮质神经元的毒性作用

探讨苯乙酸 (phenylacetic acid,PAA)对大鼠原代培养的皮质神经元的毒性作用及其作用机制。实验结果显示 ,PAA加入无血清 Neurobasal培养基可剂量依赖地损伤原代培养的皮质神经元 ,且干预培养的时间越长 ,神经元存活率越低。而同浓度 (1 .1× 1 0 -3mol/L)的 PAA对皮质神经元的损伤明显高于海马。原代培养的皮质神经元补充一氧化氮合成酶抑制剂 L- NAME、NMDA受体拮抗剂 MR- 80 1及 L型钙通道阻滞剂尼莫地平可显著地抵抗 PAA的毒性作用。以上实验结果提示 ,PAA可选择性地损伤皮质神经元 ,其毒性作用可能与 NO过量产生、兴奋性氨基酸的堆积及钙超载有关     

苯乙酸对大鼠原代皮质神经元的毒性作用

探讨苯乙酸(phenylacetic acid,PAA)对大鼠原代培养的皮质神经元的毒性作用及其作用机制.实验结果显示,PAA加入无血清Neurobasal培养基可剂量依赖地损伤原代培养的皮质神经元,且干预培养的时间越长,神经元存活率越低.而同浓度(1.1×10-3mol/L)的PAA对皮质神经元的损伤明显高于海马.原代培养的皮质神经元补充一氧化氮合成酶抑制剂L--NAME、NMDA受体拮抗剂MR-801及I-型钙通道阻滞剂尼莫地平可显著地抵抗PAA的毒性作用.以上实验结果提示,PAA可选择性地损伤皮质神经元,其毒性作用可能与NO过量产生、兴奋性氨基酸的堆积及钙超载有关.     

Paroxetine and amitriptyline in the treatment of depression in general practice

Christiansen PE, Behnke K, Black CH, Öhrström JK, Bork-Rasmussen H, Nilsson J. Paroxetine and amitriptyline in the treatment of depression in general practice. Acta Psychiatr Scand 1996: 93: 158–163. © Munksgaard 1996. A total of 144 outpatients in general practice in Denmark, aged 18–65 years and diagnosed as suffering from depression with a HAMD-17 score of 15 or more, were included in this 8-week double-blind, randomised, multicentre, controlled, parallel group comparison of paroxetine versus amitriptyline. The purpose of the study was primarily to evaluate efficacy and tolerance of treatment. In addition, focus was added on weight change and subjective well-being. The efficacy results showed equal effect of both drugs. However, paroxetine was tolerated better than amitriptyline, and this difference reached the level of significance when four non-evaluable patients were taken out of the analysis. Moreover, there was a significant weight increase in the amitriptyline group and no significant weight change in the paroxetine group. There was no difference between the groups as regards subjective well-being as measured by the VAS. In conclusion, paroxetine is an effective and well-tolerated antidepressant, and well-suited for the treatment of depression in general practice.     

The effect of fluoxetine on anxiety and depression symptoms in cancer patients

Little has been done to study the effectiveness of antidepressants in controlling anxiety/depression in a population of cancer patients. A double-blind placebo-controlled study was therefore designed to assess the effectiveness of 20 mg fluoxetine. Of 115 cancer patients who fulfilled entry criteria for levels of distress, 45 patients were randomized to a fluoxetine treatment group (FA) and 46 patients to a placebo group (PA) after a 1-week placebo period designed to exclude placebo responders. The Montgomery and Asberg Depression Scale (MADRS), the Hamilton Anxiety Scale (HAS), the Hospital Anxiety and Depression Scale (HADS), the Revised Symptom Checklist (SCL90-R) and the Spitzer Quality of Life Index (SQOLI) were used to assess the efficacy of fluoxetine. The response rate, defined by a HADS score lower than 8 after 5 weeks of treatment, was not significantly higher in the FA group (11%) compared to the PA group (7%). Compared to the PA group, patients in the FA group showed a significantly greater decrease in SCL90-R mean total score after 5 weeks, but not a greater decrease in HADS mean score. No difference between the two groups was found in observer-reported assessments (MADRS, HAS and SQOLI). Significantly more drop-outs were observed in the FA group (n=15) than in the PA group (n=7), although the frequencies of side-effects were not significantly different.     

吗氯贝胺与阿米替林治疗抑郁症的疗效比较

目的　探讨吗氯贝胺治疗抑郁症的疗效和副作用。方法　 4 8例抑郁症病人随机分为吗氯贝胺组 (2 4例 )和阿米替林组 (2 4例 ) ,共治疗 6周 ,采用HAMD和HAMA于治疗前及治疗 1、2、4、6周后进行评定 ,于治疗 6周后进行临床疗效评定及副作用评定 (TESS)。结果　吗氯贝胺组与阿米替林组治疗前后HAMD和HAMA评分均有极显著性差异 (P <0 0 1) ,吗氯贝胺组治疗 1周后呈现显著差异 (P <0 0 5 ) ,2周后呈现极显著性差异 (P <0 0 1) ,两组间同访次相比无差异性 (P >0 0 5 )。吗氯贝胺组副作用比阿米替林组明显为轻。结论　吗氯贝胺治疗抑郁症见效快 ,疗效可靠 ,副反应轻 ,依从性好 ,是治疗抑郁症的理想药物