Comparative efficacy of sertraline vs. fluoxetine in patients age 70 or over with major depression.

Using data from a larger 12-week clinical trial, the authors evaluated the comparative efficacy and safety of sertraline (n=42) and fluoxetine (n=33) in patients over age 70 with a diagnosis of major depressive disorder. Similar improvement on measures of depression, including remission of depressive symptoms, was evident, although significantly more sertraline-treated patients achieved a criterion clinical response. Significantly greater improvement for the sertraline group was apparent on the Digit Symbol Substitution Test, but not on two other measures of cognitive functioning. Although there was no difference in the rate of adverse events experienced, fluoxetine-treated patients lost significantly more body weight over the 12-week trial than did sertraline-treated patients, whereas the latter group exhibited significantly more "shaking. "     

Incidence of sexual side effects in refractory depression during treatment with citalopram or paroxetine

OBJECTIVE: The incidence of sexual dysfunction due to antidepressant drugs reported in pre-marketing clinical efficacy trials is often several times lower than in subsequent clinical experiences and independent reports. Although it is commonly believed that the reason for this discrepancy is that the nonleading questions employed in conventional clinical trials underestimate sexual dysfunction while the direct questioning used in independent trials provides more accurate data, few studies have actually compared these 2 methods. METHOD: In this study, 119 patients with a DSM-IV-defined major depressive episode (82 women and 37 men) who had been treated with but not responded to a selective serotonin reuptake inhibitor (SSRI; either citalopram or paroxetine) were assessed regarding sexual functioning by means of open-ended questions and direct questioning at baseline (after SSRI treatment only) and after 4 weeks of SSRI treatment plus buspirone or placebo. RESULTS: More patients reported sexual dysfunction in response to direct questioning (41%) as compared with spontaneous report (6%) (p < .001). Sexual dysfunction correlated with the duration of the depressive episode, but not with age, dose of SSRI, plasma level of SSRI, duration of SSRI treatment, or any measurement of depression. No statistically significant differences regarding the incidence of sexual dysfunction were found between the citalopram and the paroxetine groups. CONCLUSION: Open-ended questions are an insufficient tool to estimate sexual dysfunction, and premarketing clinical trials should therefore include basic explicit assessments. The failure to find a correlation between treatment duration and sexual dysfunction adds to the notion that sexual side effects due to SSRIs do not abate over time.     

舍曲林与帕罗西汀治疗抑郁症首次发病患者认知功能的相关研究

目的 比较舍曲林与帕罗西汀对抑郁症首次发病患者认知功能的影响及其相关因素.方法 将符合国际疾病分类第10版关于抑郁发作诊断标准、17项汉密尔顿抑郁量表(HAMD17)评分≥17分、年龄18～65岁的100例首次发病的门诊患者,按照随机数字表法分为舍曲林组(51例,剂量范围25～150 mg/d)和帕罗西汀组(49例,剂...     

西酞普兰与帕罗西汀治疗抑郁症对照研究

目的:比较西酞普兰与帕罗西汀治疗抑郁症的临床疗效和安全性. 方法:将68例符合中国精神障碍分类与诊断标准第3版抑郁发作诊断标准的患者,随机分为西酞普兰组与帕罗西汀组,疗程6周.用汉密尔顿抑郁量表(HAMD)评定疗效,用副反应量表(TESS)评定不良反应. 结果:西酞普兰组和帕罗西汀组的有效率分别为85.3%和82.4%,两组相仿.但治疗1周及2周后,西酞普兰组的有效率高于帕罗西汀组.两组间不良反应比较差异无显著性. 结论:西酞普兰是一种起效较快,且安全、有效的新型抗抑郁药.     

西酞普兰与氟西汀治疗抑郁症的对照研究

目的　比较西酞普兰与氟西汀治疗抑郁症的临床疗效及安全性。方法　将符合CCMD 3 抑郁症诊断标准的患者随机入组,各30例,分别用西酞普兰、氟西汀治疗,历时8 周,在入组时和治疗第2、4、6、8 周,用汉密尔顿抑郁量表(HAMD)评定疗效(以减分率评定出痊愈、显进、进步和无效),用副反应量表(TESS)评定副反应结果　西酞普兰组疗效稍优于氟西汀组。两组痊愈、显进、进步、无效例数分别为19,5,4,2 和17,4,5,4,显效率分别为93.3%和86.7%,但差异均无显著性(P>0.05)。前者对伴有焦虑、失眠、运动性激越效果更好,部分副反应也低于后者。治疗期间两组均未出现转躁现象。结论　西酞普兰和氟西汀治疗抑郁症疗效肯定,副反应少,对中度以上的抑郁症前者稍优于后者。     

西酞普兰与氟西汀治疗抑郁症对照研究

目的：验证西酞普兰治疗抑郁症的疗效及安全性。方法：按前瞻性，随机、单盲法将56例抑郁症患者分为西酞普兰组与氟西汀组。疗程6周。在疗前、治疗1、2、6周用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评定疗效，用副反应量表(TESS)、实验室检查及体检评价安全性。结果：两组总体疗效相当。但2周末时HAMD评分及减分率、HAMA评分两组问差异有显著性，说明西酞普兰起效较快。两组不良反应均较轻，安全性好。结论：西酞普兰是一种安全有效的抗抑郁药，耐受性及依从性好。     

Predictors of relapse during fluoxetine continuation or maintenance treatment of major depression

BACKGROUND: The goal was to examine predictors of relapse during continuation/maintenance treatment of major depression that had remitted following 12 to 14 weeks of fluoxetine therapy. METHOD: The study utilizes data collected in a collaborative clinical trial including patients with DSM-III-R major depression at 5 university-affiliated outpatient psychiatry clinics. Three hundred ninety-five patients who remitted with fluoxetine therapy were randomly assigned to 1 of 4 treatments: fluoxetine for 14 weeks followed by placebo for 36 weeks, fluoxetine for 38 weeks followed by placebo for 12 weeks, fluoxetine for 50 weeks, or placebo for 50 weeks. Cox proportional hazard models were used to identify predictors of time to relapse. RESULTS: In addition to the previously reported longitudinal pattern of response during acute treatment, neurovegetative symptom pattern was a predictor of fluoxetine benefit compared with placebo. Greater chronicity predicted poorer survival, which was not differential by treatment. The most robust advantage of fluoxetine was seen for patients with endogenous vegetative symptoms, chronic depression, and acute treatment response characterized by onset in the third week or later and persistence of response once attained. CONCLUSION: Both nonspecific pattern of response and neurovegetative symptoms characteristic of atypical depression were predictive of lack of fluoxetine efficacy in continuation/ maintenance treatment. These findings have importance for both clinical management and analyses of future maintenance trials.     

西酞普兰与氟西汀治疗抑郁症对照研究

目的 :比较西酞普兰与氟西汀治疗抑郁症的疗效及不良反应。　方法 :5 7例抑郁症患者被随机分为西酞普兰组 (2 9例 )和氟西汀组 (2 8例 )进行为期 6周的治疗。以汉密尔顿抑郁量表 (HAMD)、副反应量表 (TESS)于治疗前及治疗 1、2、4、6周末分别评定疗效和不良反应。　结果 :西酞普兰组显效率为 72 .4 % ,氟西汀组为 71.4 % ,两组间比较差异无显著性。两组HAMD评分于治疗 1、2周末差异有显著性 ,提示西酞普兰起效较早。治疗后各周两组间TESS评分比较差异均无显著性。　结论 :西酞普兰和氟西汀均有良好的抗抑郁效果。西酞普兰具有起效早、不良反应小的优点     

Serotonin and the prediction of response time to fluoxetine in patients with mild depression

Serotonin (5-HT) dysregulation has been associated with major depressive disorder (MDD); a blunted prolactin (PRL) response to D,L-fenfluramine (FEN) has been associated with MDD. Pharmacologic manipulation of the serotonin system with a selective serotonin reuptake inhibitor (SSRI) is effective in the treatment of depression. However, the relationship between pre-treatment 5-HT activity and response to SSRIs is not well understood. This study investigated the relationship between 5-HT dysregulation and response to fluoxetine (FLU). Twenty patients with MDD entered a double-blind placebo-controlled trial of fluoxetine preceded by D,L-fenfluramine stimulation. Patients were assigned randomly to either FLU, 20 mg QD, or placebo (PLA) for an 11-week trial. No relationship was found between the PRL response to FEN and response to FLU. Among the seven responding to FLU, there was a significant negative correlation between PRL response and the time until sustained response to FLU (r = -0.93, P < 0.001, n = 7). Although preliminary, this study suggests that low baseline serotonin activity may be associated with a slower response to FLU in depression.     

Benefits from mianserin augmentation of fluoxetine in patients with major depression non-responders to fluoxetine alone

OBJECTIVE: To assess, in depressed patients, the clinical benefit of mianserin augmentation of fluoxetine or the the benefit of switching treatment from fluoxetine to mianserin. METHOD: In a 6-week double-blind study we compared the therapeutic efficiency and tolerance of mianserin 60 mg/day (N = 34), mianserin 60 mg/day plus fluoxetine 20 mg/day (N = 32) and continuing fluoxetine 20 mg/day (N = 38) in patients with major depression who did not respond to previous fluoxetine treatment. RESULTS: Intent-to-treat analysis showed that at week 6 the decrease in the Hamilton Depression rating scale score was significantly (P < or = 0.03) greater in the mianserin plus fluoxetine group when compared to the fluoxetine group (effect size 0.665). Switching from fluoxetine to mianserin gave intermediate results. Mianserin augmentation of fluoxetine was well tolerated. CONCLUSION: Mianserin augmentation of fluoxetine in patients non-responders to fluoxetine 20 mg/day increases response to treatment and is well tolerated.     

西酞普兰与舍曲林治疗老年抑郁症对照研究

目的:探讨西酞普兰与舍曲林治疗首发老年抑郁症的疗效及安全性. 方法:56例首发老年抑郁症患者,分别用西酞普兰和舍曲林治疗,疗程8周.采用汉密尔顿抑郁量表(HAMD)和治疗中出现的症状量表(TESS)评定疗效及不良反应. 结果:西酞普兰和舍曲林疗效与不良反应相近,以西酞普兰组起效较快;治疗2周,两组HAMD评分比较,以西酞普兰组降分较多(P<0.05). 结论:西酞普兰和舍曲林可作为老年抑郁症的首选药物.     

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.     

Acute antidepressant response to fluoxetine and sertraline in psychiatric outpatients with psychomotor agitation

INTRODUCTION: Sertraline and fluoxetine have different pharmacologic and pharmacokinetic profiles, which may be of clinical relevance in the determination of treatment response in different subtypes of depression. OBJECTIVE: To analyse the efficacy of sertraline and fluoxetine in a subgroup of 78 patients with evidence of significant psychomotor agitation (HAM-D item 8 &#104 1 and HAM-D item 9 &#83 2 at study entry) in a 6-week study comparing sertraline (50 - 100 mg/day) and fluoxetine (20 - 40 mg/day) for the treatment of major depression in 286 psychiatric outpatients. RESULTS: The proportion of patients with psychomotor agitation responding ( &#83 50% reduction HAM-D score) at last visit was significantly ( P < 0.05) higher in the sertraline group than in the fluoxetine group (62% vs 39%, respectively). Most of the secondary efficacy parameters showed significantly ( P &#104 0.05) greater improvement in the sertraline treatment group at last visit: HAM-D &#104 8, HAM-D total score, HAM-D anxiety/somatization factor, HAM-D weight factor, HAM-A total score, CGI-S, Raskin Depression score, and Covi Anxiety score. CONCLUSION: The findings of this retrospective data analysis suggest that fluoxetine may be a less efficacious antidepressant than sertraline in patients with psychomotor agitation.     

Effect of concurrent anxiety on response to sertraline and imipramine in patients with chronic depression

Anxiety commonly complicates the clinical presentation of depression and has been associated with poorer long-term outcome, but little information is available on the clinical correlates, and comparative effect on treatment response, of subsyndromic or secondary anxiety. Patients diagnosed with chronic major or double depression were randomized to 12 weeks of double-blind treatment with either sertraline or imipramine in a 2:1 ratio. A high anxiety subgroup was operationally defined by a HAM-D anxiety/somatization factor score > or = 7. The effect of study treatment was measured utilizing the HAM-D, CGI, HAM-D anxiety/somatization factor, as well as a quality of life measure (Q-LES-Q) and a measure of psychosocial functioning (the MOS-SF-36). Two hundred nine patients were treated with imipramine and 426 patients were treated with sertraline. Thirty-six percent of the total met criteria for the high anxiety subgroup. According to Kaplan-Meier probability estimates, patients with significant concurrent anxiety symptoms were more likely to respond by 12 weeks (66.4%) than those without significant anxiety symptoms (54.2%). There was no significant difference in response rates for sertraline vs. imipramine. Both drugs were effective at treating high baseline levels of anxiety, with 60% of sertraline patients and 58% of imipramine patients having 50% or greater reduction from baseline in HAM-D anxiety/somatization factor scores, and only 4.6% and 9.9%, respectively, reporting treatment-emergent worsening in anxiety at study endpoint. Despite the chronicity of depressive illness, acute treatment with both sertraline and imipramine significantly improved psychosocial and quality of life measures. High baseline levels of anxiety did not reduce overall antidepressant response but did somewhat delay the onset of response to sertraline or imipramine in patients with chronic depression.     

Efficacy and response time to sertraline versus fluoxetine in the treatment of unipolar major depressive disorder

BACKGROUND: Few studies have compared the treatment efficacy of the 2 selective serotonin reuptake inhibitors sertraline and fluoxetine. METHOD: A randomized, single-blind, parallel-group study of 10 weeks' duration comparing the efficacy of sertraline, 50 mg/day; sertraline, 100 mg/day; and fluoxetine, 20 mg/day, was conducted in 44 psychiatric outpatients with DSM-IV unipolar major depressive disorder. Antidepressant dosages were doubled at 6 weeks for subjects who had not achieved remission. Primary outcome measurements included the 21-item Hamilton Rating Scale for Depression (HAM-D) and the Clinical Global Impressions-Improvement scale (CGI-I), with scores of < or = 7 on the HAM-D and < or = 2 on the CGI-I representing a positive treatment response, i.e., remission. RESULTS: At 4 weeks, significant differences in rate of positive treatment response were noted, with 0% for sertraline, 50 mg; 46% for sertraline, 100 mg; and 31% for fluoxetine, 20 mg (p = .023). At 6 weeks, positive treatment response rates were 21%, 43%, and 31% for subjects taking 50 mg of sertraline, those taking 100 mg of sertraline, and those taking 20 mg of fluoxetine, respectively, with treatment groups no longer differing significantly from each other. In subjects for whom antidepressant dose was doubled at week 6, response rates at week 10 (4 weeks on increased dose) were 40% for sertraline, 100 mg; 43% for sertraline, 200 mg; and 55% for fluoxetine, 40 mg. CONCLUSION: Subjects taking sertraline, 100 mg, and fluoxetine, 20 mg, demonstrated an earlier treatment response compared with subjects taking sertraline, 50 mg. For patients without a positive response at 6 weeks, an increased antidepressant dose resulted in remission for a substantial proportion of patients when assessed 4 weeks later.     

First experiences in combination therapy using olanzapine with SSRIs (citalopram, paroxetine) in delusional depression

In an open prospective study, 26 patients with delusional depression (mood-congruent psychotic features: DSM-IV 296.4) were treated over 5 weeks with a combination of SSRI (citalopram, n = 22, or paroxetine, n = 4) and the neuroleptic olanzapine. The course of therapy was evaluated with the Hamilton depression scale (HAMD). Not only the total HAMD score, but also the subscores for affectivity and delusional symptoms decreased significantly. After the end of the 5-week combination therapy, 18 out of 26 patients (69%) could be discharged as responders to outpatient treatment. The course of treatment was characterized by excellent tolerance.     

氟西汀治疗抑郁症的疗效及其对无效者的治疗对策

目的 为了解氟西汀治疗抑郁症的疗效及其对无效者的治疗方法。方法 对78例首次服用氟西汀的抑郁症病人进行两年的随访，其中19例氟西汀治疗无效的病人加用低剂量的维思通治疗，15例因经济条件差而停服氟西汀造成病情复发者给予换用氯丙咪嗪治疗，且对这两组进行对照分析。结果 氟西汀的按期有效率达93.59%，对19例加用低剂量的维思通治疗在1周内迅速起效，15例换用氯丙咪嗪治疗者1例无效，2例因不能忍受药物副反应而停药。氟西汀联用低剂量的维思通治疗组较氯丙咪嗪治疗组起效快，症状改善迅速，但两组病人在治疗第6周HAMD评分无显著差异。结论 对SSRI无效者联用低剂量的维思通治疗是有效的，氟西汀的近期疗效是肯定的，而远期疗效亦应引起临床重视。