米氮平替换三环类抗抑郁药治疗抑郁症对照研究

目的:了解米氮平替换三环类抗抑郁药(TCAs)治疗抑郁症的有效性和安全性.方法:将经TCAs足量治疗6周疗效好转及以下的抑郁症患者随机分为米氮平组和TCAs组.米氮平组渐停TCAs,渐加米氮平治疗;TCAs组继续使用TCAs治疗.采用Hamilton抑郁量表(HAMD)、大体评定量表(GAS)、临床疗效总评量表的病情严重程度(CGI-SI),分别于入组时,治疗1、2、4、8周末评定其病情变化;治疗中出现的症状量表(TESS)评定不良反应.结果:米氮平组治疗2周各量表评分即显著好转,TCAs组治疗4周HAMD、GAS评分有显著性好转,CGI-SI评分治疗8周末差异有显著性下降.米氮平组不良反应发生率显著少于TCAs组.结论:米氮平替换TCAs治疗抑郁症安全有效.     

Personality disorders in dysthymia and major depression.

OBJECTIVE: The purpose of the present study was to investigate the comorbidity of personality disorders in patients with primary dysthymia compared to those with episodic major depression. METHOD: A total of 177 out-patients with primary dysthymia and 187 outpatients with episodic major depression were administered a structured diagnostic interview for DSM-III-R Axis II disorders. In addition, all of these patients completed the BDI, and those with the appropriate level of education also completed the Minnesota Multiphasic Personality Inventory (MMPI). RESULTS: A significantly higher proportion of dysthymic patients than patients with major depression met the criteria for a personality disorder, for borderline, histrionic, avoidant, dependent, self-defeating types and for personality disorders of clusters B and C. Further analysis revealed that the above differences were mainly due to the subgroup of patients with 'early-onset dysthymia'. Finally, patients with a personality disorder, both dysthymics and those with major depression, had significantly higher scores on the BDI and on the majority of the MMPI scales compared to those without a personality disorder. CONCLUSION: The data indicated that (i) dysthymia--mainly that of early onset--is associated with significantly higher personality disorder comorbidity than episodic major depression, and (ii) the presence of a personality disorder is related to more severe overall psychopathology.     

女性复发性抑郁症共病心境恶劣的临床特征

目的:探讨女性复发性抑郁症患者共病心境恶劣的临床特征。方法:采用复合性国际诊断用检查访谈(CIDI)将301例女性复发性抑郁症患者分为共病心境恶劣组(共病组,26例)及非共病心境恶劣组(非共病组,275例);对两组的人口学资料、抑郁症临床特征、父母亲情关系量表(PBI)、艾森克神经质量表、生活应激事件量表评分进行比较。结果:两组人口学资料比较差异无统计学意义;与非共病组的临床资料相比,共病组抑郁症总病程更长[(14.1±9.5)年vs.(10.4±8.3)年;P=0.032],起病年龄更小[(30.9±8.3)岁vs.(36.1±9.4)岁;P=0.003],发病次数更多[(5.8±5.3)vs.(4.1±4.9);P=0.047],阳性家族史及有自杀行为比率更高(34.6%vs.18.5%,P=0.049;38.5%vs.20.4%,P=0.033);艾森克神经质评分明显增高[(13.3±6.0)vs.(10.6±5.7);P=0.025];二元Logistic回归分析显示,PBI母亲保护评分、共病焦虑障碍及生活压力事件是共病心境恶劣的因素(P0.05或P0.01)。结论:共病心境恶劣的女性复发性抑郁症患者其抑郁症病情更为严重;母亲过度保护、共病焦虑障碍及生活压力事件是其相关因素。     

西酞普兰与氟西汀治疗恶劣心境对照研究

目的：探讨西酞普兰与氟西汀治疗恶劣心境的疗效和安全性。方法：将116例恶劣心境患者随机分为西酞普兰组和氟西汀组,治疗6周,用汉密尔顿抑郁量表（HAMD）和治疗中出现的症状量表（TESS）评定疗效和不良反应。结果：西酞普兰组和氟西汀组总体疗效相当,西酞普兰起效较快,不良反应较轻。结论：西酞普兰治疗恶劣心境既有效又安全。     

Differential effect of chronic desipramine and amitriptyline treatment on rat brain adrenergic and serotonergic receptors

Serotonergic and adrenergic receptors were examined in rat brains by direct binding assays after chronic treatment with tricyclic antidepressants. Chronic amitriptyline (AMT) treatment (10 mg/kg/day i. p.for 21 days) decreased specific ³H-spiperone binding in the cortex and not in the caudate nuclei. Specific ³H-dihydroalprenolol (³H-DHA) binding was reduced in cerebellar but not in cerebral cortex. Chronic desipramine (DMI) treatment given in the same dose schedule, on the other hand, decreased specific ³H-DHA binding in both cerebellar and cerebral cortex. Specific ³H-spiperone binding in the cerebral cortex was also reduced but to a lesser extent than that in the AMT treated group. Scatchard analysis showed that reductions in ³H-spiperone or ³H-DHA binding in all cases were due to decreases in number of binding sites (Bmax) and not to changes in dissociation constants (K_D). No change was observed in ³H-serotonin (³H-5HT), ³H-clonidine, or ³H-WB-4101 binding. The results show that there is no single common change in brain adrenergic and serotonergic receptors after chronic AMT and DMI treatment.     

抑郁症与心境恶劣障碍患者的甲状腺素水平

目的:测定抑郁症与心境恶劣障碍患者的甲状腺素水平,探讨其神经内分泌改变。方法:对抑郁症30例和心境恶劣障碍30例进行汉密尔顿抑郁量表(HAMD),艾森克人格问卷(EPQ)及生活事件量表(LES)评定。测血清三碘甲状腺原氨酸(T3)、甲状腺素(T4)及促甲状腺素(TSH)浓度。结果:两组间在HAMD总分及T4水平差异显著。抑郁症组T3与EPQ的内外向分及HAMD的迟缓因子分呈正相关;T4与HAMD总分、焦虑因子分及负性生活事件刺激量呈正相关;TSH与正性生活事件刺激量呈正相关。心境恶劣障碍组T3与认知障碍因子分呈负相关;T4与HAMD总分、负性生活事件及迟缓因子分呈正相关。结论:负性生活事件促进了抑郁发作,T4水平可预测抑郁症状的严重程度。     

Prediction of therapeutic response in acute treatment with antidepressants

Summary A study was carried out involving 159 endogenous depressive inpatients treated with antidepressants. Using standardized rating instruments, a large set of potential predictor variables was tested. After cross-validation according to the split-half technique, only very few of these proved to be suitable as predictors for the main outcome criteria. These predictors included premorbid maladjustment, neurotic traits of premorbid personality, intensity of depressive-apathetic symptoms at admission, and the self-evaluated mood assessment score 3 weeks after commencement of treatment. This last criterion demonstrated the highest predictive value. Several predictors known from the literature could not be reproduced in this study.     

Predicting the onset of major depressive disorder and dysthymia in older adults with subthreshold depression: a community based study

BACKGROUND: It is well-established that the incidence of major depressive disorder is increased in subjects with subthreshold depression. A new research area focuses on the possibilities of preventing the onset of major depressive disorders in subjects with subthreshold depression. An important research question for this research area is which subjects with subthreshold depression will develop a full-blown depressive disorder and which will not. METHODS: We selected 154 older subjects with subthreshold depression (CES-D>16) but no DSM mood disorder from a longitudinal study among a large population based cohort aged between 55 and 85 years in The Netherlands. Of these subjects, 31 (20.1%) developed a mood disorder (major depression and/or dysthymia) at three-year or six-year follow-up. We examined risk factors and individual symptoms of mood disorder as predictors of onset of mood disorder. RESULTS: Two variables were found to be significant predictors in both bivariate and multivariate analyses: eating problems and sleep problems. The incidence of mood disorders differed strongly for different subpopulations, varying from 9% (for those not having any of the two risk factors) to 57% (for those having both risk factors). CONCLUSIONS: It appears to be possible to predict to a certain degree whether a subject with subthreshold depression will develop a mood disorder during the following years.     

A double-blind comparison of the efficacy and safety of paroxetine and imipramine in the treatment of depression with dementia

Objectives. To compare the efficacy of paroxetine and imipramine prospectively in patients with coexisting depression and dementia. Methods. An 8-week, double-blind, parallel group trial comparing paroxetine 20–40 mg/day with imipramine 50–100 mg/day in 198 patients aged 60 years or over with a Montgomery–Asberg Depression Rating Scale (MADRS) score ≥20 and a Folstein mini-mental state evaluation score of 17–23 points after a 3- to 7-day placebo run-in period. Results. Both paroxetine and imipramine reduced the MADRS and the Clinical Global Impression (CGI) severity-of-illness and global improvement scores at weeks 2, 4, 8 and at endpoint, with no significant differences between treatment groups at any timepoint (MADRS, p≥0.368; cgi, p≥0.286). There was a statistically significant difference in favour of paroxetine at both the week 4 and week 8 timepoints (analysis of variance, p≤0.049) in the Cornell scale for depression in dementia: at endpoint there was no significant difference between treatments (p=0.103). Treatment-emergent adverse experiences were reported by 51.5% (51/99) of patients treated with paroxetine and 50.5% (50/99) of patients treated with imipramine. Anticholinergic adverse experiences (paroxetine 6.1%; imipramine 13.1%) and serious non-fatal adverse experiences (paroxetine 4.0%; imipramine 8.1%) were reported by more patients in the imipramine group than in the paroxetine group. Conclusions. Paroxetine and imipramine were both effective in the treatment of depression in elderly subjects with co-existing dementia, and no significant differences were detected between the groups. There were trends suggesting that paroxetine was better tolerated than imipramine in terms of anticholinergic adverse experiences and serious non-fatal adverse experiences. © 1998 John Wiley & Sons, Ltd.     

The prevalence of current major depression and dysthymia in a Norwegian general practice

Existing studies suggest that depression is underdiagnosed and undertreated in general practice, and that the known prevalence of this mood disorder in a primary care population may represent only the ‘tip of the iceberg'. A total of 100 consecutive patients in an average Norwegian general practice were tested, of whom 31 patients were diagnosed as having a depressive illness in this study; 28 patients were diagnosed as having current major depression and three as having dysthymia. In total, 21 of the 28 patients with current major depression presented with other symptoms as their major complaints at the consultation in which they were tested. Twelve of these 21 patients had some kind of pain problem.     

Lipid and lipoprotein levels in depressive disorders with melancholic feature or atypical feature and dysthymia

The purpose of the present study was to explore the relationship between serum lipid and lipoprotein levels and clinical subtypes in patients with depressive disorders. A total of 207 patients who were admitted for general health screening were assessed by using the semistructured clinical interview for Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) criteria for the possibility of having depressive disorders. Blood and physical examinations were done to rule out systemic diseases. A total of 142 patients without systemic diseases was recruited for further analysis, including dysthymia (n = 35), major depressive disorder with melancholic feature (n = 22), major depressive disorder with atypical feature (n = 46) and normal controls (n = 39). Analysis of covariance after age adjustment reveals significant differences in patients with melancholic feature and patients with atypical feature in serum concentrations of triglyceride (TG) and very-low-density-lipoprotein cholesterol (VLDL) in men, and high-density-lipoprotein cholesterol (HDL) in women. This suggests that the TG, VLDL and HDL levels might be used as biological markers to differentiate between major depressive patients with melancholic feature or atypical feature.     

Quality of life in schizophrenia and dysthymia

Quality of life (QOL) was assessed in three groups of patients, consisting of 30 schizophrenic patients with duration of illness < 2 years, 30 schizophrenic patients with duration of illness ≥2 years and 30 dysthymic patients. The diagnoses were made according to ICD-10. Two scales of quality of life were used, one of which was specific for schizophrenia, while the other was generic for all patients. On inter-group comparison the two schizophrenia groups did not show significant differences in quality of life, but on comparing schizophrenic and dysthymic patients, significant differences emerged. Dysthymic patients were significantly less satisfied than schizophrenic patients with duration of illness < 2 years in the domain of physical health. In the domains of satisfaction with medication and leisure-time activities, both schizophrenic groups were significantly more satisfied than the dysthymic group. Comparison of the quality of life ratings of our patients with those of a well-known study from Sweden revealed some significant differences which relate to the domains of work, contacts, inner experience and leisure-time activities. Cultural factors are invoked to account for these differences. The need for refinement of assessment of quality of life in multi-racial and multi-ethnic contexts is stressed.     

Course of clinical response to antidepressants

1. The postulated pharmacological mechanisms of antidepressant effect are reviewed.

2. The clinical profile of response to antidepressants are linked to the pharmacological mechanisms.

3. The limitations of presently available instruments for diagnosis and measurement of change in depression are discussed.     

Short psychodynamic supportive psychotherapy, antidepressants, and their combination in the treatment of major depression: a mega-analysis based on three randomized clinical trials

The efficacy of Short Psychodynamic Supportive Psychotherapy (SPSP) has not yet been compared with pharmacotherapy. A mega-analysis based on three original Randomized Clinical Trials (RCTs) was performed. Patients with (mild to moderate) major depressive disorder were randomized in (24 weeks) SPSP (n = 97), pharmacotherapy (n = 45), or their combination (n = 171). Efficacy was assessed by the Hamilton Depression Rating Scale (HDRS), Clinical Global Impression of Severity and of Improvement (CGI-S), the Symptom Checklist (SCL; depression subscale) and the Quality of Life Depression Scale (QLDS). Pearson chi(2) calculations were used to compare success rates. Analyses of covariance (ANCOVAs) were used to test inter-group differences. Success rates indicated that independent observers (HDRS) found no differences in symptom reduction between SPSP and pharmacotherapy (P = 0.214), but therapists (CGI-S, P = 0.026), and patients (SCL, P = 0.036) favored SPSP. Combined therapy was found superior to pharmacotherapy by all three (patients (P = 0.000), therapists (P = 0.024), independent observers (P = 0.024)). Independent observers (P = 0.062) and therapists (P = 0.430) found no differences between combined therapy and SPSP, but patients (P = 0.016) found combined therapy to be superior. As far as quality of life is concerned, success rates indicated that patients (QLDS) found no differences between SPSP and pharmacotherapy (P = 0.073) or between SPSP and combined therapy (P = 0.217). However, they found combined therapy superior to pharmacotherapy (P = 0.015). The results of the mega-analysis suggest that combined therapy is more efficacious than pharmacotherapy. SPSP and pharmacotherapy seem equally efficacious, except for some indications that patients and therapists favor SPSP for symptom reduction. Combined therapy and SPSP also seem equally efficacious, except that patients think that the first is better in symptom reduction.