西酞普兰治疗老年抑郁症的效果及不良反应观察

目的：探讨西酞普兰治疗老年抑郁症的效果及不良反应。方法选择收治的老年抑郁症患者72例,随机分为对照组和观察组,对照组仅使用阿米替林治疗,观察组使用西酞普兰治疗,并根据汉密尔顿抑郁量表（ HAMD）及不良反应表（ TESS）对两组情况进行评定。结果观察组总有效率88．89％,对照组总有效率80．56％,两组相比差异无统计学意义（P＞0．05）;但治疗后观察组HAMD评分（7．5±1．2）显著低于对照组（8．4±1．4）;且观察组不良反应评分（8．13±0．3）,显著低于对照组（8．41±0．2）,差异有统计学意义（P＜0．05）。结论西酞普兰和阿米替林治疗老年抑郁症效果相似,但西酞普兰引起的不良反应较少,患者痛苦小,值得临床推广。     

西酞普兰治疗躯体形式障碍的临床对照观察

目的 探讨西酞普兰治疗躯体形式障碍的临床疗效和安全性。方法将80例躯体形式障碍患者随机分为两组,分别给予西酞普兰和阿米替林进行为期6周的治疗研究,采用汗密顿抑郁量表（HAMD）、副反应量表（TESS）于治疗前和治疗1、2、4、6周末分别评定疗效及不良反应。结果西酞普兰和阿米替林治疗躯体形式障碍的疗效相似,但西酞普兰比阿米替林起效快,不良反应少而轻,疗效指数优于阿米替林（P〈0．05）。结论西酞普兰治疗躯体形式障碍疗效好、起效快且安全。     

米氮平与阿米替林治疗抑郁症的对照研究

目的比较米氮平与阿米替林治疗抑郁症的疗效和不良反应。方法应用米氮平和阿米替林治疗抑郁症各30例,应用汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）进行评定,并进行临床疗效比较。结果米氮平与阿米替林治疗后HAMD、HAMA分值均显著下降,两组间减分比较,差异无显著性,米氮平不良反应发生率明显少于阿米替林。结论米氮平治疗抑郁症疗效与阿米替林相当,前者不良反应较轻,值得推广。     

度洛西汀与阿米替林治疗抑郁症的对照研究

目的比较度洛西汀与阿米替林治疗抑郁症的疗效和不良反应。方法应用度洛西汀和阿米替林治疗抑郁症各30例,应用汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）进行评定,并进行临床疗效评定。结果度洛西汀与阿米替林治疗后HAMD、HAMA分值均显著下降,两组间减分比较,差异无显著性,度洛西汀不良反应发生率明显少于阿米替林。结论度洛西汀是治疗抑郁症的一种安全有效的药物。     

西酞普兰单用与西酞普兰与齐拉西酮合用治疗抑郁症的疗效对比观察

目的探讨西酞普兰与齐拉西酮合用治疗伴躯体症状抑郁症的疗效。方法将46例伴躯体障碍的抑郁症患者随机分为单用西酞普兰组和西酞普兰与齐拉西酮合用组,进行8周的治疗,采用汉密顿抑郁量表（HAMD）、副反应量表（TESS）和自编躯体症状调查表进行测评。结果在抑郁症缓解方面两组均显效;对于躯体症状的改善,合并组优于单用组。两组副作用均较小。结论西酞普兰与齐拉西酮合用治疗伴躯体障碍抑郁症效果优于单用西酞普兰。     

西酞普兰与氯米帕明治疗抑郁症患者对照研究

西酞普兰为新型抗抑郁药,为了解该药的临床疗效及副作用,以西酞普兰与氯米帕明治疗抑郁症作临床对照研究,现报道于下.     

西酞普兰合并小剂量氯氮平治疗抑郁症的疗效

目的：探讨西酞普兰合并小剂量氯氮平治疗抑郁症的疗效。方法：将80例抑郁症患者随机分成西酞普兰组（单用组）和西酞普兰合并小剂量氯氮平组（合用组）。共观察6周。于治疗前、后1、2、4、6周末采用汉密尔顿抑郁量表（HAMD）,不良反应量表（TESS）评定疗效及不良反应。结果：治疗每6周末西酞普兰合并小剂量氯氮平组疗效显著。合用组与单用组的有效率分别为85.2%和61%,有显著差异（χ^2=4.031,P〈0.05）使用组在1周内起效,单用组在两周末起效。两组治疗后1、2、4周HAMD评分显著性差异（P〈0.05）;TESS评分无明显差异（P〉0.05）。结论：西酞普兰合并小剂量氯氮平治疗抑郁症起效快,睡眠明显改善。克服了抗抑郁药起效慢的特点。     

老年抑郁症的临床特征及西酞普兰的治疗效果

目的分析老年抑郁症的临床特征,评价西酞普兰治疗老年抑郁症的疗效和安全性。方法用西酞普兰治疗35例老年首发抑郁症患者,在治疗前及治疗第2、6周末行汉密尔顿抑郁量表（HAMD）及副反应量表评定临床疗效及安全性。根据HAMD各项评分总结老年抑郁症主要症状。结果抑郁情绪、睡眠障碍、焦虑、全身症状和疑病是这组患者的主要表现。西酞普兰治疗2周后HAMD评分较治疗前下降,差异明显（t=10.401,P〈0.05） 治疗6周后HAMD评分与治疗前比较明显降低,差异显著（t=15.815,P〈0.05）,治疗6周后显效率为66%,不良反应轻微。结论西酞普兰治疗老年抑郁症疗效显著,安全性高。     

艾司西酞普兰与帕罗西汀治疗首发抑郁症的对照研究

目的 探讨艾司西酞普兰与帕罗西汀对首发抑郁症治疗的临床疗效和安全性.方法 将76例首发抑郁症患者随机分为艾司西酞普兰组（治疗组）和帕罗西汀组（对照组）,疗程8周.采用汉密尔顿抑郁量表（HAMD）在治疗前及治疗后1、2、4、6、8周评定疗效 用不良反应症状量表（TESS）评定不良反应.结果 在治疗的第一周、第二周末,艾司西酞普兰组的HAMD分值均低于帕罗西汀组,两组分值差异有统计学意义（P〈0.05）,而在第4、6、8周末,两组患者的HAMD分值差异无统计学意义.在治疗8周末时,艾司西酞普兰组有效率92.1%,显效率86.8%,帕罗西汀组分别为92.1%、84.2%.两组差异无统计学意义.在不良反应方面,两组差异无统计学意义.结论 艾司西酞普兰和帕罗西汀治疗首发抑郁症疗效相当,不良反应较少,安全性较好.但艾司西酞普兰起效更快,有利于迅速缓解患者症状.     

高压氧联合西酞普兰治疗抑郁症睡眠障碍患者的临床疗效观察

目的:探讨高压氧(HBO)联合西酞普兰治疗抑郁症睡眠障碍患者的临床疗效及其作用机制。方法:收集2016年3月至2019年6月在山西白求恩医院精神卫生科诊治的抑郁症睡眠障碍患者140例,按随机数字表法分为观察组和对照组,每组70例。对照组给予西酞普兰治疗,观察组给予西酞普兰联合HBO治疗,均治疗4周后观察2组患者的治疗效果、抑郁评分、睡眠障碍情况以及血清白细胞介素-1(IL-1)、IL-6、肿瘤坏死因子-α(TNF-α)和皮质醇水平。结果:治疗4周后,观察组患者治疗总有效率(94.29%)显著高于对照组(77.14%),差异有统计学意义( P<0.05);治疗后2组患者睡眠质量、入睡时间、抑郁状态评分均显著低于治疗前,且观察组治疗后下降更显著,差异均有统计学意义( P<0.05或 P<0.01);治疗后2组患者的IL-1、IL-6、TNF-α和皮质醇水平均明显低于治疗前,且观察组治疗后较对照组下降更显著,差异有统计学意义( P<0.05或 P<0.01)。 结论:HBO联合西酞普兰治疗可降低抑郁症睡眠障碍患者血清IL-1、IL-6、TNF-α、皮质醇水平,显著改善抑郁状况和睡眠障碍,有较好的临床疗效。     

A report on autopsy cases involving amitriptyline and nortriptyline

Summary The concentration and distribution of amitriptyline and nortriptyline in different parts of the body of 55 autopsy cases are reported. The cases are grouped into three categories: i) cases in which poisoning by ami- or nortriptyline seemed to have been the only cause of death, (ii) cases of mixed poisoning by these two drugs and other compounds and/or ethanol, and finally (iii) deaths by physical means where ami- or nortriptyline was found but did not play a direct role in the lethal outcome.The severity of the intoxication by ami- or nortriptyline is best judged by the concentration of the drug (and its metabolites) in the liver, in a similar fashion as for the phenothiazine drugs discussed in an earlier paper.The autopsies reported in this paper have been performed by Drs. K. Boström, B. Falconer, P. Geertinger, H. Glaumann, S. Jacobsson, H. Knutson, B. Larsson, S. O. Lidholm, J. Lindberg, A. Lindgren, I. Lingmark, L. Rammer, T. Saldeen, Hj. Sjövall, G. Voigt, B. Zetterlund, and one of us (G.S.).     

Individual variations of amitriptyline biotransformation examined in scalp hair samples

The identification of amitriptyline, nortriptyline and its hydroxy-metabolites including a subsequent measurement of concentration profiles in hair samples was carried out to evaluate the administration history of amitriptyline. Analyses were carried out using liquid chromatography—tandem mass spectrometry, which permits simultaneous identification of all relevant substances in hair at low target concentrations (limit of detection better than 0.5 pg/mg). Standard hair sample preparation was applied for the estimation of average substance concentration in a hair bundle, while segmentation of individual hairs was utilised to examine accurate concentration profiles. Replication of analyses demonstrated a good reproducibility of individual hair concentration profiles, which proved to coincide for all relevant compounds. Significant variations of metabolite ratios (e.g. nortriptyline to amitriptyline and E10- to Z10-hydroxynortriptyline) between individuals suggest a correlation between hair concentration and metabolic phenotype. Different concentration ratios of certain metabolites in hair are highly correlated, indicating a systematic association between demethylation and stereo-specificity of hydroxylation. The trans isomers of hydroxy-metabolites become significantly more prevalent with increasing degree of demethylation of amitriptyline or hydroxylation of amitriptyline. The data were presented at the Hair Testing Meeting, Vadstena, Sweden, May 2006. We hereby state that we do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article.     

A fatal poisoning case of acetone cyanohydrin and citalopram

Acetone cyanohydrin (ACH) is a readily available source of cyanide and is widely used in basic and applied sciences. In toxicology, ACH is classified as extremely hazardous as it readily decomposes on contact with water, with the potential rapid release of highly toxic hydrogen cyanide (HCN). We report the case of a young woman found dead from the intentional ingestion of ACH and citalopram, an antidepressant of the selective serotonin reuptake inhibitor class. The autopsy findings included bright reddish-purple hypostasis and mild pulmonary edema. As ACH can decompose to acetone and HCN, we quantified the concentration of each compound and thiocyanate separately in various body fluids and organs and determined their whole-body distributions by using gas chromatography–mass spectrometry (GC–MS). We observed high concentrations of both acetone and cyanide in the blood (0.63 mg/mL and 17.99 mM, respectively) and gastric contents (9.76 mg/mL and 472.44 mM). The whole-body distributions of acetone and cyanide were similar (i.e., the concentration of each compound was the highest in the lung, followed by the heart, and then the liver). Our results suggest that not only the route of administration but also the dose taken could greatly affect the body distributions of cyanide in humans. In addition, as toxicological screening detected citalopram, which was not prescribed to the deceased, we performed a chiral analysis by using liquid chromatography–tandem mass spectrometry (LC–MS/MS). We determined that only (S)-citalopram was ingested antemortem; its concentration was 0.36 μg/mL, which is in the toxic range.     

圣·约翰草提取物治疗抑郁症临床观察

 目的评价圣·约翰草提取物治疗抑郁症的临床疗效和安全性.方法78例抑郁症患者随机分为2组,分别给予圣·约翰草提取物(路优泰)和盐酸阿米替林治疗,疗程8周.采用汉密顿抑郁量表(HAMD),汉密顿焦虑量表(HAMA),临床总体评定量表(CGI)评定临床疗效,不良反应评价用副反应量表(TESS)、实验室检查及体检.结果经8周治疗,圣·约翰草提取物组有效率为85.37%,阿米替林组为89.19%,两组比较差异无统计学意义(P＞0.05).圣·约翰草提取物抗焦虑症状的疗效明显优于阿米替林(P＜0.01),不良反应轻微.结论圣·约翰草提取物是一种安全、有效、具有较好抗焦虑作用的抗抑郁剂.     

Correlation of inter-individual variations of amitriptyline metabolism examined in hairs with CYP2C19 and CYP2D6 polymorphisms

The metabolite ratio of amitriptyline (AT), nortriptyline (NT) and its 10-hydroxy metabolites (E10-OHAT, Z10-OHAT, E10-OHNT and Z10-OHNT) was examined by liquid chromatography-mass spectrometry in hair samples of 23 white infants after long-term administration of AT. High inter-individual variation of the metabolite ratios were observed (e.g. NT/AT = 0.8–8.1, E10-OHNT/Z10-OHNT = 1.6–10.3). The significance of these variations was proven by confirmation of the temporary stability of these ratios within a hair fibre. Moreover, an association of the metabolic phenotype with genetic disposition was observed. The genotypes of CYP2C19 (alleles *2, *3 and *4) and of CYP2D6 (*3, *4, and *6) were examined by conventional polymerase chain reaction genotyping experiments. The relative amount of demethylation (NT/AT) is clearly affected by the number of functional alleles of CYP2C19. The demethylation capacity of CYP2C19 poor metabolizers (3 individuals, compared to 15 extensive metabolizers) was 4.3 times depleted. Moreover, the selectivity of hydroxylation (e.g. E10-OHNT/Z10-OHNT) is significantly correlated with CYP2C19. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Response-dependent differences in regional cerebral blood flow changes with citalopram in treatment of major depression.

Major depression (MD) is the most frequent psychiatric disorder with a predicted increase within the next decade. The understanding of the neurobiologic basis of its cause, antidepressive treatment effects, and identification of treatment outcome predictors is of crucial importance to warrant efficient medical care. The aim of our study was to investigate differences of regional cerebral blood flow (rCBF) in MD between responders and nonresponders in the beginning and differences during the course of treatment. METHODS: 99mTc-Labeled d,l-hexamethylpropyleneamine oxime brain scans under resting conditions were performed on 65 patients with MD. All patients were treated with citalopram as an antidepressive monotherapy. SPECT scans were performed 2 times, at the beginning (t1) and after 4 wk of medication (t2). Voxel-by-voxel analyses were performed using SPM. Unpaired t test, paired t test, and multigroup analysis were used on a significance threshold of P < 0.005 (uncorrected) to identify significant differences in rCBF between responders and nonresponders at t1, within both groups over time of treatment (t2-t1), as well as a group x time interactions. RESULTS: Thirty-five patients responded after 4 wk of treatment. Distinct differences between responders and nonresponders were found at the beginning of treatment and also relating to changes in rCBF during treatment. Responders showed a higher posterior cingulate activity at t1. Furthermore, an opposite direction of rCBF changes during treatment could be observed in this area. CONCLUSION: The differences in rCBF in responders and nonresponders in the posterior cingulate at t1 and the opposite directed changes in rCBF in both groups during treatment in this region suggest that the posterior cingulate function plays a key role in the pathophysiology of depression and may have a predictive value for antidepressive treatment outcome.     

磁共振成像技术在评价抑郁症疗效方面的研究进展

磁共振成像技术能在脑结构和功能层面揭示抑郁症患者存在的脑组织异常,并对治疗效果起到评估作用。本文简述了磁共振成像特别是DTI与BOLD-fMRI技术在评价抑郁症疗效应用上的研究近展。