丁螺环酮联合米氮平治疗老年期抑郁症的对照研究

目的观察丁螺环酮联合米氮平治疗老年期抑郁症的疗效和安全性。方法57例老年抑郁症患者分为2组,丁螺环酮联合米氮平治疗30例,为研究组,单用米氮平27例,为对照组。采用汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）和不良反应量表（TESS）分别观察疗效和不良反应,连续观察6周。结果 在治疗第1周,2组HAMD和HAMA评分均下降,但2组间有显著性差异（P〈0．01）。第2周末开始2组间HAMD和HAMA评分差异无显著性。第6周末2组显效率分别为83．3％和81．5％,差异无统计学意义（P〉0．05）。2组间TESS评分每周差异亦无统计学意义（P〉0．05）。结论 丁螺环酮联合米氮平治疗老年期抑郁症起效更快,病人的满意度和依从性更好。     

度洛西汀治疗抑郁症的疗效观察

目的探讨度洛西汀对抑郁症的疗效和安全性。方法 70例抑郁发作患者随机分为度洛西汀组和氟西汀组,每组35例,分别给予度洛西汀和氟西汀治疗,疗程6周。用汉密尔顿抑郁量表（HAMD）评定疗效,用不良反应量表（TESS）评定不良反应。结果治疗1～2周,度洛西汀组HAMD评分较氟西汀组显著下降（P〈0.05）,治疗4～6周,两组相仿（P〉0.05）。两组间不良反应差异无显著性（P〉0.05）。结论度洛西汀是一种起效较快,且安全、有效的新型抗抑郁药。     

度洛西汀治疗慢性阻塞性肺疾病患者抑郁焦虑症状的疗效

目的探讨度洛西汀治疗慢性阻塞性肺疾病(COPD)患者抑郁焦虑症状的疗效及安全性,并评价其对患者生活质量的影响。方法采用汉密顿抑郁量表(HAMD)及汉密尔顿焦虑量表(HAMA)测量患者的心理状况,将存在轻中度焦虑、抑郁症状的稳定期COPD患者共51例分为度洛西汀组(28例)及对照组(23例),治疗4 w后再检测COPD的各项指标,并用圣乔治呼吸问卷(SGRQ)评价生活质量,应用TESS副反应量表记录药物副反应。结果度洛西汀治疗4 w末,度洛西汀组生活质量各评分与对照组比较有显著性差异(P<0.01),HAMD及HAMA评分明显降低(P<0.01),有效率为96.4%。结论度洛西汀能明显提高COPD患者的生活质量,改善患者的焦虑及抑郁症状,治疗期间无明显不良反应。     

度洛西汀与帕罗西汀对老年抑郁症患者主观睡眠质量的影响

目的探讨度洛西汀与帕罗西汀治疗老年抑郁症的临床疗效及对主观睡眠质量的影响。方法 71例老年抑郁症患者随机分为研究组36例,口服度洛西汀治疗,对照组35例,口服帕罗西汀治疗,观察8 w。应用汉密尔顿抑郁量表(HAMD)总分评价疗效,HAMD睡眠障碍因子和匹兹堡睡眠指数(PSQI)评定睡眠改善效果,副反应量表(TESS)评定不良反应。结果研究组治疗第1、2周末HAMD评分较对照组下降更显著(P均0.05)。治疗8 w末,研究组总有效率(77.8%)与对照组(74.3%)无显著差异(P0.05)。两组不良反应较轻,两组TESS评分差异无显著性(P均0.05)。研究组治疗第1、2周末HAMD睡眠障碍因子和PSQI评分较对照组下降更显著(P均0.05),治疗4 w后两组无显著差异(P均0.05)。结论度洛西汀与帕罗西汀治疗老年抑郁症疗效显著且相当,安全性高,但度洛西汀起效更快,并在治疗早期对患者的主观睡眠改善优于帕罗西汀。     

西酞普兰与帕罗西汀治疗焦虑抑郁共病临床对照观察

目的比较西酞普兰与帕罗西汀对焦虑抑郁共病治疗的有效性和安全性。方法收集焦虑抑郁共病患者50例,随机分为两组,分别给予西酞普兰和帕罗西汀单盲对照治疗6周。采用17项汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)和不良反应量表(TESS)评定疗效及安全性。结果两组总体疗效差异无统计学意义,治疗第2周两组HAMD、HAMA总分均有显著下降(P0.01),且不良反应少。结论西酞普兰与帕罗西汀治疗焦虑抑郁共病疗效相当,安全性高,而西酞普兰不良反应更轻一些。     

氟西汀治疗老年抑郁症的疗效与安全性

目的探讨氟西汀治疗老年抑郁症的临床疗效与安全性。方法将60例老年抑郁症患者随机分为研究组(氟西汀治疗)和对照组(氯丙咪嗪治疗),每组30例,观察8周,用汉密尔顿抑郁量表(HAMD)和副反应量表(TESS)评定临床疗效和不良反应。结果治疗8周后,2组临床疗效无显著性差异,HAMD评分2组治疗后均较治疗前显著下降(P<0.01),但2组间差异无统计学意义(P>0.05),不良反应发生率和TESS评分研究组显著低于对照组(P<0.01)。结论氟西汀治疗老年期抑郁症疗效确切,与氯丙咪嗪相当,但不良反应少而轻,安全性好。     

艾司西酞普兰与舍曲林治疗老年抑郁症疗效研究

目的 探讨艾司西酞普兰治疗老年抑郁症的疗效及安全性. 方法 68例老年抑郁症患者随机分为艾司西酞普兰组与舍曲林组,疗程4周.采用汉密尔顿抑郁量表(HAMD)评定疗效,不良反应量表(TESS)评定不良反应. 结果 艾司西酞普兰组显效率为82.4%,舍曲林组为79.4%,2组比较差异无显著性(P>0.05);艾司西酞普兰治疗组第1周末与舍曲林组HAMD评分比较有显著性差异(P＜0.05).艾司西酞普兰组不良反应发生率为38.2%,舍曲林组为44.1%,2组比较差异无显著性(P>0.05). 结论 艾司西酞普兰与舍曲林治疗老年抑郁症疗效相当,艾司西酞普兰起效较舍曲林快.     

度洛西汀治疗体位性低血压伴焦虑抑郁的疗效观察

目的观察度洛西汀对伴有焦虑抑郁的体位性低血压的疗效和安全性。方法筛选2013年3月—2015年3月河北医科大学第一医院门诊或病房收治的体位性低血压病人30例,其中合并焦虑抑郁情绪者16例,采用度洛西汀治疗(度洛西汀组),另14例采用盐酸米多君治疗(米多君组)。在用药前及用药2周、8周后,根据1周内头晕、晕厥发生的次数、立卧位血压的变化、皮肤交感反应(SSR)、汉密尔顿焦虑量表(HAMA)14、汉密尔顿抑郁量表(HAMD)24的变化评定药物疗效,用不良反应量表(TESS)评定用药的安全性。结果药物疗效评价:头晕、晕厥的每周发生次数:两组治疗后均较治疗前有明显下降(P0.001),在治疗第8周末,度洛西汀组1周内头晕、晕厥发生的次数明显低于米多君组[(2.05±1.98)次/周vs(6.28±2.15)次/周,t=5.609,P0.001]。立卧位血压:度洛西汀组和米多君组收缩压及舒张压与用药前相比均明显降低(P0.01)。皮肤交感反应变化:两组治疗后潜伏期较治疗前缩短(P0.05),波幅较治疗前升高(P0.05)。度洛西汀组治疗后HAMA14分值(F=297.57,P0.001)、HAMD24分值(F=180.16,P0.001)与治疗前相比均有明显下降。TESS评定:两组间的药物不良反应比较差异无统计学意义(P0.05)。结论度洛西汀不但能改善体位性低血压病人的焦虑抑郁情绪,而且通过提高立位血压,可有效缓解体位性低血压导致的眩晕及晕厥,改善自主神经功能。     

西酞普兰合并丁螺环酮治疗老年抑郁症临床观察

目的探讨西酞普兰合并丁螺环酮治疗老年抑郁症的疗效与安全性。方法将50例老年抑郁症患者随机分为研究组(西酞普兰合并丁螺环酮治疗)和对照组(单用西酞普兰治疗),每组25例,观察12周。用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)和不良反应量表(TESS)分别评定临床疗效和不良反应。结果在治疗后8、12周末,研究组痊愈率(56%、76%)和显效率(88%、92%)显著高于对照组(28%、48%和56%、64%),P均<0.05;2组在治疗2周后HAMD、HAMA评分均较治疗前显著下降(P<0.05),同期比较,治疗前和治疗2周末2组间HAMD、HAMA评分无显著差异(P>0.05),在第4周后,研究组显著低于对照组(P<0.05或P<0.01);2组TESS评分无明显差异(P>0.05)。结论西酞普兰合并丁螺环酮治疗老年抑郁症比单用西酞普兰疗效优越,且不良反应少而轻微,临床使用安全,也有利于提高治疗依从性。     

疏肝解郁胶囊联合草酸艾司西酞普兰治疗抑郁症伴焦虑症的疗效观察

目的观察疏肝解郁胶囊联合草酸艾司西酞普兰治疗抑郁症伴焦虑症的临床疗效。方法将90例抑郁症伴焦虑症状病人采用数字表法随机分成观察组与对照组,每组45例。对照组予草酸艾司西酞普兰治疗,观察组予疏肝解郁胶囊联合草酸艾司西酞普兰治疗,疗程共6周。分别于治疗前及治疗第3周末、第6周末进行汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、副反应量表(TESS)评分,比较两组治疗效果和安全性。结果两组治疗第6周、第3周HAMD和HAMA评分与治疗前比较,差异有统计学意义(P 0.05);两组治疗第6周末HAMD和HAMA评分与治疗第3周末比较,差异有统计学意义(P 0.05);两组治疗第6周、第3周HAMD和HAMA评分比较,差异有统计学意义(P 0.01)。对照组与观察组不良反应发生率比较差异无统计学意义(2.33%与4.54%,P0.05)。结论疏肝解郁胶囊联合草酸艾司西酞普兰治疗抑郁症伴焦虑症状有增效作用,安全性好。     

度洛西汀联合认知行为干预治疗胆汁反流性胃炎并抑郁症患者疗效观察

[目的]观察度洛西汀联合认知行为干预治疗胆汁反流性胃炎合并抑郁症患者的临床疗效。[方法172例胆汁反流性胃炎合并抑郁症患者随机分为2组,2组患者均给予常规治疗,治疗组加用度洛西汀联合认知行为干预治疗。[结果]2组治疗后临床疗效、镜下表现及抑郁自评量表评分比较差异有统计学意义（P〈O．05）。[结论]度洛西汀联合认知行为干预治疗胆汁反流性胃炎合并抑郁症患者临床疗效满意。     

度洛西汀治疗老年支气管哮喘患者伴发抑郁的疗效分析

目的探讨度洛西汀联合心理治疗老年支气管哮喘伴发抑郁患者的疗效和不良反应。方法 64例老年支气管哮喘患者伴发抑郁患者随机分成两组,合用组为度洛西汀联合心理治疗,单用组为度洛西汀,疗程为6周。采用汉密顿抑郁量表(HAMD-17)评定疗效,用症状量表(TESS)评定用药不良反应。结果治疗6周末,合用组有效率为87.5%,单用组有效率为68.75%,两组比较差异有显著性(χ2=4.27,P<0.05)。两组TESS评分比较差异无显著性(t=1.25,P>0.05)。结论度洛西汀联合心理治疗老年支气管哮喘伴发抑郁患者疗效好,安全性高,依从性好。     

Impact of comorbidities on pharmacotherapy of painful diabetic neuropathy in clinical practice

AimsWe evaluated the impact of baseline comorbidities on the effectiveness of duloxetine and anticonvulsants (pregabalin/gabapentin) in patients with painful diabetic neuropathy in clinical care.MethodsOutcomes from a 6-month, observational study with 2575 patients initiating/switching DPNP treatment were analyzed post-hoc. Propensity scoring was used to adjust for baseline factors influencing treatment choice in 1523 patients receiving duloxetine or anticonvulsants. Analysis of covariance models with fixed effects for baseline pain, treatment, propensity score, baseline characteristics or comorbidities, and their interaction with treatment were used to estimate LSmean effects on Brief Pain Inventory (BPI) average pain and interference scores.Results89.5% of patients reported comorbidities, including hypertension (70.5%), hyperlipidemia (39.2%), and depression (24.8%). Macrovascular complications (37.0%) and ‘other chronic pain’ (41.5%), particularly joint pain had an impact on both pain treatments, i.e. less improvement of average pain and interference of pain. Better treatment responses with duloxetine vs. anticonvulsants were observed in patients with depression, those with high baseline BPI total interference score, especially general activity, and in patients with joint pain.ConclusionsComorbidities such as macroangiopathy and depression as well as pain characteristics should be considered in the treatment of DPNP as they may predict the effectiveness of duloxetine and anticonvulsants.     

度洛西汀联合米氮平治疗老年抑郁症伴失眠的临床分析

目的 分析度洛西汀联合米氮平治疗老年抑郁症伴失眠的临床效果以及对抑郁症状、睡眠治疗的影响.方法 回顾性分析2019年1月-2020年6月在中国解放军联勤保障部队第904医院常州医疗区就诊的86例老年抑郁症伴失眠患者的病例资料,根据治疗方式不同将其分为2组,其中接受度洛西汀单独治疗43例为单独治疗组,接受度洛西汀联合米氮...     

度洛西汀联合认知疗法治疗持续性躯体形式疼痛障碍的疗效观察

目的观察度洛西汀联合认知疗法治疗持续性躯体形式疼痛障碍(PSPD)的效果。方法选择2012年8月—2013年3月在我院门诊就诊的PSPD患者70例,将其随机分为研究组和对照组。两组均应用度洛西汀治疗,起始剂量为30 mg/d;在此基础上研究组联合认知疗法。以治疗6周末疼痛量表(MOSPE)减分率评定疼痛疗效,两组患者均在治疗前、治疗2周、4周、6周末采用汉密尔顿抑郁量表(HAMD)评分。结果治疗6周末研究组有效率为82.9%(29/35),对照组有效率为77.1%(27/35),两组有效率比较,差异无统计学意义(χ2=0.36,P0.05)。治疗4周、6周时,研究组HAMD评分低于对照组(P0.05)。结论度洛西汀适用于PSPD的治疗,且疗效较好,耐受性较好,联合认知疗法有助于尽快改善患者的抑郁症状。     

Duloxetine for the long-term treatment of Major Depressive Disorder in patients aged 65 and older: an open-label study

Background  

Late-life depression is a common, chronic and recurring disorder for which guidelines recommend long-term therapy. The safety and efficacy of duloxetine for the treatment of major depressive disorder (MDD) were evaluated using data from elderly patients (age ≥ 65 years; n = 101) who participated in a large, multinational, open-label study.     

Late-onset minor and major depression: early evidence for common neuroanatomical substrates detected by using MRI

The purpose of our study was to examine the neuroanatomical correlates of late-onset minor and major depression and to compare them with similar measures obtained from nondepressed controls. Our study groups were comprised of 18 patients with late-onset minor depression, 35 patients diagnosed with late-onset major depression, and 30 nondepressed controls. All subjects were scanned by using a 1.5-tesla MRI scanner. Absolute whole brain volume and normalized measures of prefrontal and temporal lobe volumes were obtained and used for comparison among groups. Our findings indicate that patients with minor depression present with specific neuroanatomical abnormalities that are comparable with the major depression group but significantly different from the controls. Normalized prefrontal lobe volumes show a significant linear trend with severity of depression, with volumes decreasing with illness severity. Whole brain volumes did not differ significantly among groups. These findings have broad implications for the biology of late-life depression and suggest that there may be common neurobiological substrates that underlie all clinically significant forms of late-onset mood disturbances.     

Duloxetine-induced Syndrome of Inappropriate Secretion of Antidiuretic Hormone in a Super-elderly Patient

Duloxetine is widely used for pain control and depressive syndromes. One of its potential side effects is syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Duloxetine-induced SIADH causes hyponatremia, which leads to a variety of symptoms and has previously been reported in the elderly. In the present case, we experienced a case of the rapid onset of SIADH in a super-elderly woman receiving low-dose duloxetine. Elderly patients tend to have lower duloxetine doses and an earlier onset than non-elderly patients. When hyponatremia occurs after duloxetine administration, duloxetine-induced SIADH should be considered, especially in high-risk elderly patients, regardless of the duloxetine dose or duration of treatment.     

Enzyme Replacement Therapy Improves Respiratory Outcomes in Patients with Late-Onset Type II Glycogenosis and High Ventilator Dependency

Purpose

Type II glycogenosis (GSDII) is a rare and often fatal neuromuscular disorder caused by acid alpha-glucosidase deficiency. Although alglucosidase alfa enzyme replacement therapy (ERT) significantly improves outcomes in subjects with the infantile form, its efficacy in patients with the late-onset one is not entirely clear. The long-term efficacy of ERT in late-onset GSGII complicated by severe pulmonary impairment causing high mechanical ventilation dependency was investigated in this study.

Methods

The long-term clinical efficacy of ERT was assessed in eight late-onset GSDII patients using home mechanical ventilation (HMV) by comparing their outcomes with those of six historical control patients (GSDII patients) who had received HMV alone. The number of hospitalizations due to pulmonary exacerbations and of hours of daily use of HMV were considered the study’s primary efficacy endpoints.

Results

The treatment group showed an increased tendency toward shorter follow-up compared to the control group (35.8 ± 29.2 vs. 52.6 ± 8.55 months; p = 0.04). At the end of the study period, the daily use of HMV (12.5 ± 7.6 vs. 19 ± 14.3 h; p = 0.004) and the hospitalization rate [incidence rate ratio = 0.43 (95 % confidence interval 0.18–0.93); p = 0.03] were significantly lower in the patients receiving ERT. The differences in the forced vital capacity absolute value and percentage change from baseline were not significantly different in the two groups.

Conclusions

ERT reduces ventilator dependency in late-onset GSDII patients and the need for hospitalization due to respiratory exacerbations.     

西酞普兰联合丁螺环酮治疗老年期抑郁症

目的 探讨丁螺环酮对西酞普兰治疗老年抑郁症的增效作用。方法 67例老年抑郁症患者随机分为研究组（西酞普兰联合丁螺环酮治疗，n=31）和对照组（单一西酞普兰治疗，n=36），观察12周。采用汉密尔顿抑郁量表（HAMD-17）、汉密尔顿焦虑量表（HAMA-17）、临床疗效总评量表（CGI-GI）和不良反应量表（TESS）分别观察疗效和不良反应。结果 在治疗第1周末，2组HAMD-17、HAMA-17评分即开始下降；研究组第4周末HAMD-17评分和第8周末的HAMA-17评分均低于对照组，第12周末CGI-GI评分优于对照组（P〈0．05），2组间TESS评分比较差别无统计学意义（P〉0．05）。结论 西酞普兰联合丁螺环酮治疗老年抑郁症可以增加疗效，且耐受性良好。