文拉法辛与帕罗西汀治疗抑郁症的临床效果观察

目的 探讨文拉法辛缓释剂和帕罗西汀治疗抑郁症的效果.方法 选择本院2012年6月～2013年3月收治的抑郁症患者60例,随机分为A、B两组,其中A组给予文拉法辛缓释剂治疗,B组给予帕罗西汀治疗,两组均治疗2个月,采用汉密尔顿抑郁量表（HAMD）、临床疗效总体评价量表（CGI）评价治疗效果,观察两组治疗不良反应情况.结果 两组治疗后HAMD、CGI量表评分均较治疗前降低（P＜0.05）.治疗1周时,A组HAMD评分明显低于B组（P＜0.05）,治疗4、8周时两组HAMD评分差异无统计学意义（P＞0.05）;治疗1、4、8周时两组CGI评分差异均无统计学意义（P＞0.05）;治疗后两组有效率比较,差异无统计学意义（P＞0.05）.两组治疗过程中均出现口干、便秘、恶心、心电图异常等不良反应,但组间差异无统计学意义,且不良反应经对症处理后均减轻或消失,未影响治疗.结论 文拉法辛缓释剂和帕罗西汀治疗抑郁症的疗效无明显差异,安全性均较高,但文拉法辛起效时间较帕罗西汀短,值得应用.     

盐酸文拉法辛缓释片治疗脑卒中后抑郁的疗效和安全性

目的评价盐酸文拉法辛缓释片治疗脑卒中后抑郁的临床效果。方法选取2010年3月~2013年2月本院收治的91例脑卒中后抑郁患者,随机分为两组,其中观察组45例采用盐酸文拉法辛缓释片治疗,对照组46例采用阿米替林口服治疗,观察并比较两组患者的临床疗效、HAMD评分及不良反应发生情况。结果观察组总有效率为95.6%,对照组总有效率为84.8%,两组患者临床疗效比较,差异有统计学意义（P〈0.05）;两组治疗后HAMD评分较治疗前显著下降（P〈0.01）,观察组治疗后1周较对照组下降明显（P〈0.05）,治疗4周及8周与对照组比较,差异无统计学意义（P〉0.05）;观察组TESS评分显著低于对照组,提示观察组不良反应发生明显轻于对照组（P〈0.05）,观察组的不良反应多出现于治疗早期,随着治疗持续,不良反应逐渐减轻。结论盐酸文拉法辛缓释片治疗脑卒中后抑郁疗效好,安全系数高,值得在临床推广。     

A double-blind, randomized, 26-week study comparing the cognitive and psychomotor effects and efficacy of 75 mg (37.5 mg b.i.d.) venlafaxine and 75 mg (25 mg mane, 50 mg nocte) dothiepin in elderly patients with moderate major depression being treated in general practice

To investigate the efficacy and cognitive and psychomotor effects of venlafaxine and dothiepin in elderly patients with moderate major depression. A prospective, randomized, double-blind, parallel-group, active comparator controlled study was conducted. Eighty-eight patients (aged > or = 60 years) were enrolled. Each patient received either venlafaxine (immediate release formulation) 37.5 mg twice per day or dothiepin 25 mg mane followed by 50 mg nocte for 26 weeks. Efficacy was assessed with the Montgomery-Asberg Depression Rating Scale and the Hamilton Depression Rating Scale. A psychometric test battery to assess cognitive function, activities of daily living and sleep consisted of Critical Flicker Fusion (CFF), Short-term Memory--Kim's Game, Cognitive Failures Questionnaire, Milford Epworth Sleepiness Scale, Leeds Sleep Evaluation Questionnaire, and an Accident Scoring Questionnaire. Quality of Life Questionnaires (Short Form 36 and Quality of Life in Depression Scale) were also administered. Venlafaxine significantly (p < 0.05) raised CFF scores compared to baseline but had no effect on any other measure. Dothiepin significantly (p < 0.05) lowered CFF threshold, and increased ratings of both sedation and difficulty in waking. The results showed that venlafaxine at doses of 37.5 mg b.i.d. in elderly depressed patients is free from disruptive effects on cognitive function and psychomotor performance.     

文拉法辛缓释剂治疗抑郁症的双盲、随机、平行对照、多中心临床研究

目的 :比较文拉法辛缓释剂与氟西汀治疗抑郁症的疗效及安全性。方法 :文拉法辛缓释剂组(文拉法辛组 ) 6 4例 ,年龄为 4 1a±s 13a ,氟西汀组6 3例 ,年龄为 4 2a± 12a。按双盲双模拟法文拉法辛组用量 75m·d- 1,qd或氟西汀组用量 2 0mg·d- 1,qd。共 6wk。疗效评定采用HAMD ,HAMA及CGI。安全性评价应用TESS、实验室检查及体检。结果 :经过 6wk治疗 ,文拉法辛组痊愈率 6 9% ,有效率为 83%。氟西汀组的痊愈率 5 9% ,有效率为 71% ,P >0 .0 5。另外 ,文拉法辛组的抗抑郁作用起效较快 ,对伴随的焦虑症状也有较好疗效。文拉法辛组不良反应轻 ,安全性好 ;常见不良反应有 :恶心、呕吐、口干及出汗等。结论 :文拉法辛缓释剂是一种安全而有效的抗抑郁药 ,病人对药物的耐受性及依从性好     

Comparison of efficacy and tolerability of reboxetine and venlafaxine XR in major depression and major depression with anxiety features: an open label study

OBJECTIVE: The aim of this study was to compare the efficacy and tolerability of reboxetine in the treatment of major depressive disorder (MDD) and MDD with anxiety features to venlafaxine XR. METHOD: Patients with MDD, aging 18 between 65 years, were randomly allocated to two groups receiving either open-label venlafaxine XR capsules (n = 50) or reboxetine tablets (n = 43). Subjects were administered Hamilton Depression Rating Scale (HAM-D) and Hamilton Anxiety Scale (HAM-A) at baseline and 2, 4, 7, 10 weeks after the baseline visit. RESULTS: Response rates to antidepressant treatment were significantly higher in the venlafaxine XR group at 10th week. When patients having anxious depression were analysed separately; response rate for anxiety of reboxetine group was significantly higher at 7th week only. Mean number of side effects were significantly higher in reboxetine group. Only one subject in each group was dropped out due to side effect. CONCLUSION: We may suggest that reboxetine is as effective and tolerable as venlafaxine XR in the treatment of MDD and MDD with anxiety features, and it may be considered a treatment option to venlafaxine XR.     

文拉法辛联合拉莫三嗪治疗难治性抑郁症的临床研究

目的:探讨文拉法辛联合拉莫三嗪治疗难治性抑郁症的辅助效果及安全性。方法:将60例难治性抑郁症患者随机分为两组:对照组30例,单用文拉法辛(150～225 mg/d)治疗;治疗组30例,在采用文拉法辛(150～225 mg/d)治疗的同时,联合应用拉莫三嗪(100～300 mg/d)。两组持续治疗观察期均为12周。于入组前、入组后第6周和第12周末分别应用汉密尔顿抑郁量表、Qids-C16抑郁症状学记录量表及副反应量表进行评定。结果:①治疗第6,12周末,两组间HAMD、Qids-C16评分的差异有统计学意义(P<0.05或P<0.01)。②治疗组的总有效率为96.67%,对照组的总有效率为50%,两组间的差异有统计学意义(P<0.01)。③治疗组患者中10例出现不良反应,占33.3%;对照组为9例,占30.0%,两组患者的副反应均较轻微。结论:文拉法辛联合拉莫三嗪治疗难治性抑郁症的疗效优于单用文拉法辛,安全性较好,可用于临床治疗。     

文拉发辛与阿米替林治疗抑郁症患者的疗效和依从性比较

目的 比较抑郁症患者服用文拉发辛与阿米替林治疗的疗效和依从性.方法 120例住院抑郁症患者随机分为服用文拉发辛组与阿米替林组,均治疗52周,用汉密尔顿抑郁量表(HAMD)等,在治疗前及治疗后12周、52周末比较2组的疗效和依从性.结果 12周后2组治疗前后比较均有非常显著性的疗效(P＜0.01),但2组间比较差异无显著性(P＞0.05),52周后文拉发辛组具有非常显著性的疗效(P＜0.01),阿米替林组具有显著性的疗效(P＜0.05),2组间比较差异显著(P＜0.05),文拉发辛组副反应发生率远低于阿米替林组.结论 文拉发辛治疗抑郁症疗效好,副反应轻,依从性高.     

Resilience as a predictor of treatment response in patients with posttraumatic stress disorder treated with venlafaxine extended release or placebo

This post-hoc analysis evaluated resilience as a predictor of treatment response in patients with posttraumatic stress disorder (PTSD). Data were pooled from two randomized, double-blind studies conducted with adult outpatients treated with flexible doses of venlafaxine extended release (ER) 37.5 to 300 mg/day or placebo. The 17-item Clinician-Administered Posttraumatic Stress Disorder Scale (CAPS-SX(17)) was the primary outcome measure. Baseline Connor-Davidson Resilience Scale (CD-RISC) scores for the 25-, 10-, and 2-item versions were used to predict changes in PTSD symptom severity at week 12 and symptomatic remission (CAPS-SX(17) ≤ 20). Analyses were conducted for the overall population and separately for the individual treatment groups. In total, pretreatment resilience predicted a positive treatment response. For the overall population, all versions of the CD-RISC predicted CAPS-SX(17) change scores and remission after controlling for variables such as treatment group and baseline symptom severity. For venlafaxine ER-treated patients, all versions of the CD-RISC were predictive of remission, but only the 10-item version was predictive of CAPS-SX(17) change score. Our results suggest that higher pretreatment resilience is generally associated with a positive treatment response. Future research may be warranted to explore the relationship between response to active treatment and the spectrum of resiliency.     

Efficacy of venlafaxine and predictors of response in a prospective open-label study of patients with treatment-resistant major depression

The aim of this study was to replicate the findings of a 1994 study, in which a 30% response rate to venlafaxine was found in patients with treatment-refractory depression, as well as to examine for any predictors of such an outcome. The study was an 8-week, open-label, prospective investigation of venlafaxine in doses up to 300 mg in 312 patients fulfilling criteria for either "absolute" or "relative" treatment resistance. By week 8, 52.6% of the patients had responded, which was defined as a 50% reduction in scores on the Montgomery-Asberg Depression Rating Scale; 49% of those defined with "absolute resistance" demonstrated such an outcome. Forty-five percent of the patients with absolute resistance who had failed to respond to at least one tricyclic antidepressant responded to venlafaxine. Response rates were higher in those with an absence (57.5%) compared with the presence (31.0%) of any comorbid psychiatric disorder (p < 0.001), "marked" (60.3%) compared with "mild or moderate" (51.6%) or "severe" (43.4%) baseline ratings on the patient-rated Clinical Global Impressions Scale (p < 0.05), and "relative" (61%) compared with "absolute" resistance (49%) (p = 0.06). Furthermore, improvement in scores of 20% or 30% at weeks 1 or 2 was associated with higher rates of final response (p < 0.0005). After logistic regression, both comorbid psychiatric illness (p < 0.001) and early improvement (p < 0.0001) remained significant and independent predictors of final response.     

文拉法辛与马普替林对照治疗抑郁症83例

目的：比较文拉法辛与马普替林治疗抑郁症的疗效及安全性。方法：83例抑郁症患者随机分为2组。文拉法辛组41例给万拉法辛50－200mg，po,bid；马普替林组40例给马普替林25－150mg,po,bid；均6周为1个疗程。结果：文拉法辛组有效率为87.8%，马普替林组有效率为87.5%，两者疗效无统计学差异（P＞0.05)。治疗1周末，文拉法辛组HAMD评分明显低于马普替林组（P＜0.01)。药物不良反应发生率文拉法辛组低于马普替林组。结论：文拉法辛抗抑郁的疗效与马普替林相当，但比后者起效快、不良反应发生率低。     

博乐欣缓释片治疗抑郁症患者效果评价

目的 探讨博乐欣缓释片治疗抑郁症的临床治疗效果及安全性.方法 将2014年9月至2016年9月我院精神科门诊收治的80例抑郁症患者作为研究对象,随机分为对照组和观察组各40例,对照组采用氯丙咪嗪治疗,观察组采用博乐欣缓释片治疗,分别用汉密尔顿抑郁量表(HAMD-24)、抑郁自评量表(SAS)及副作用量表(TESS)评分观察两组患者对不良情绪状况的改善情况及用药安全性,并观察比较两组患者治疗期间的用药不良反应.结果 用药治疗后,观察组HAMD评分及SAS评分低于对照组,差异具有统计学意义(P<0.05);观察组治疗2周末及治疗4周末的TESS评分(4.12±0.98,5.07±1.23)低于对照组(4.89±1.76,6.21±2.11),差异具有统计学意义(P<0.05);观察组患者不良反应发生率(10.00%)低于对照组(37.50%),差异具有统计学意义(P<0.05).结论 采用博乐欣缓释片治疗抑郁症患者,可改善患者抑郁与焦虑的不良心理状态,患者用药后不良反应发生率低,安全性高.     

A double-blind study comparing the efficacy and tolerability of mirtazapine and doxepin in patients with major depression

One hundred and sixty-three patients with major depression were randomly assigned to treatment with mirtazapine or doxepin for 6 weeks in a double-blind clinical trial. Initially, patients received mirtazapine 20 mg/day or doxepin 75 mg/day, dosages were then titrated up to a maximum of 60 mg/day and 300 mg/day, respectively. Both drugs produced considerable improvement in depressive symptoms with no statistically significant differences between the two patient groups. In the mirtazapine group only two patients prematurely terminated the study due to adverse drug experiences, as compared to six in the doxepin-treated group. Moreover, doxepin-treated patients complained more frequently of dry mouth and movement disorders. In conclusion, mirtazapine is an effective treatment for major depression and appears to offer advantages in tolerability over doxepin.     

盐酸帕罗西汀肠溶缓释片治疗重性抑郁障碍的临床疗效和安全性

目的 评价帕罗西汀肠溶缓释片(抗重性抑郁障碍药)治疗重性抑郁障碍的疗效和安全性.方法 用随机双盲对照多中心临床研究方法,帕罗西汀肠溶缓释片组(n=209)25～62.5 mg·d-1;帕罗西汀速释片组(n=209)20～50 mg·d-1,疗程8周.结果 帕罗西汀肠溶缓释片组和速释片组研究终点的HAMD-17评分相对基线分别下降了14.8(7.0)分和15.1(6.7)分,HAMD-17评分相对基线变化的最小二乘方均数(LS means)分别为-14.9分和-15.2分,组间差异(0.3分)无统计学意义(P>0.05),组间差异的95%CI(-1.0,1.6)上限小于方案所设定的非劣效界值(2.5),表明帕罗西汀肠溶缓释片治疗重性抑郁障碍非劣效于帕罗西汀速释片.因胃肠道不良事件而暂停试验或提前退出研究的比例,肠溶缓释片组患者低于速释片组(3.4%vs 7.3%).结论 治疗中国重性抑郁障碍患者,帕罗西汀肠溶缓释片非劣效于帕罗西汀速释片,安全性相似,肠溶缓释片可能有更好的胃肠道耐受性.     

A randomized, double-blind, 24-week study of escitalopram (10 mg/day) versus citalopram (20 mg/day) in primary care patients with major depressive disorder

OBJECTIVE: A randomized, double-blind, 24-week-fixed-dose study comparing the efficacy and safety of escitalopram to that of citalopram was safety was conducted in primary care patients with moderate to severe major depressive disorder (MDD). RESEARCH DESIGN AND METHODS: This was a randomized, double-blind, 24-week fixeddose study. Patients were randomly assigned to treatment with escitalopram 10 mg/day (n = 175) or citalopram 20 mg/day (n = 182). Clinical response was evaluated using the Montgomery-Asberg Depression Rating Scale (MADRS) and Clinical Global Impression-Severity (CGI-S) scale. The prospectively defined primary parameter of antidepressant efficacy was the change from baseline in the mean MADRS total score during the 24 weeks of double-blind treatment, using a repeated measures analysis of variance to compare the treatment groups over all assessment points simultaneously. RESULTS: Based on the primary parameter, escitalopram was at least as efficacious as citalopram. Based on the prospectively defined secondary parameter, mean change from baseline in the CGI-S score, escitalopram was statistically significantly superior to citalopram at Week 24. The importance of long-term treatment could be demonstrated, in that more than half (55% and 51%) of the patients who had not responded by Week 8 achieved remission by Week 24. Both escitalopram and citalopram were safe and well tolerated in acute and long-term treatment, and the overall adverse event profiles for the two drugs were similar. For the intent-to-treat population, there were statistically significantly fewer withdrawals in the escitalopram group than in the citalopram group, particularly after Week 8. CONCLUSION: Patients with MDD responded well to long-term treatment with either escitalopram or citalopram. This study demonstrated the importance of extending treatment of depression beyond 8 weeks.     

Continuation and maintenance treatment of major depression with the monoamine oxidase inhibitor phenelzine: a double-blind placebo-controlled discontinuation study

Long-term treatment with antidepressant drugs has received little attention until recently. A study is reported comparing the effectiveness of maintenance treatment with phenelzine in responding major depression patients. If they responded initially to nonblind phenelzine treatment and sustained remission for 16 weeks, patients were randomized to 2-year double-blind treatment with phenelzine 60 mg/day, phenelzine 45 mg/day, or placebo. Both doses of phenelzine were significantly better than placebo in preventing relapse of depression. Phenelzine 45 mg/day may be an optimal maintenance dose for many patients.     

The efficacy of divalproex sodium in the treatment of agitation associated with major depression

BACKGROUND: Agitation is both a feature of major depression and a common side effect of antidepressant treatment. Depressive agitation correlates with overall severity of illness and suicide risk, whereas treatment-emergent agitation may contribute to early discontinuation of pharmacotherapy. Thus, agitation merits investigation as a treatment target in clinical depression. METHODS: In this study, adults with major depression were evaluated for change in agitation and other mood symptoms during adjunctive treatment with divalproex sodium. Twelve patients on antidepressants, who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for major depression, were given low doses of divalproex sodium and evaluated repeatedly for symptoms of depression, anxiety, and agitation. Agitation severity was evaluated using the Overt Agitation Severity Scale and the Stanford Scale for Agitation Symptoms. Mood symptoms were assessed with the Hamilton Anxiety and the Hamilton Depression Rating Scales. RESULTS: Nine of 12 patients completed 4 weeks of treatment. All agitation scores decreased sharply, whereas depression (Hamilton Depression Rating Scale) and anxiety (Hamilton Anxiety Rating Scale) symptoms decreased only modestly. Decreased agitation was not merely a function of decreases on the Hamilton Depression or Hamilton Anxiety Rating Scales. Relatively low doses of divalproex sodium appear to be useful in the treatment of agitation associated with major depression. CONCLUSIONS: The observation that decreases in agitation were not simply an artifact of overall change in depressive or anxiety symptoms is in keeping with the previous clinical impression that divalproex sodium has a specific effect on depressive agitation. Controlled clinical trials are needed to fully evaluate the utility and symptom specificity of divalproex sodium in depression.     

Comparison of the efficacy and systemic effects of 4 mg and 8 mg formulations of salbutamol controlled release in patients with asthma

The purpose of the present study was to compare the efficacy and systemic effects of 4 mg and 8 mg doses of salbutamol controlled release (SCR) after single dosing and at steady state in patients with asthma. Fifteen asthmatic patients (Age 36 y, FEV1 85% predicted) were given SCR 4 mg and 8 mg twice daily for 7 days in a randomised double-blind cross-over design, with at least 7 days washout between treatments. There were no differences between the bronchodilator effects of 4 mg and 8 mg doses. There was no evidence of tolerance to the bronchodilator effects after chronic dosing. Morning and evening PEFR measurements also showed improvements during treatment with SCR 4 mg and SCR 8 mg, although there were no differences between the two formulations. Both doses of SCR caused significant objective tremor responses which were maintained after chronic dosing. The 8 mg dose produced a larger tremor response after single dosing, but not at steady-state. Subjective tremor occurred in 7 patients with SCR 8 mg, and in 2 patients with SCR 4 mg. There were no cardiac arrhythmias on Holter ECG monitoring. These results suggest that the 8 mg dose of SCR was no more effective than the 4 mg formulation, and was associated with more systemic adverse effects.     

Mirtazapine orally disintegrating tablets versus venlafaxine extended release: a double-blind, randomized multicenter trial comparing the onset of antidepressant response in patients with major depressive disorder

This randomized, multicenter, double-blind study was designed to compare specifically the onset of antidepressant action of mirtazapine orally disintegrating tablets (ODT) with venlafaxine extended-release (XR) formulation in outpatients with major depression. Both treatments were administered in a rapidly escalating dosing regimen. Target doses (mirtazapine ODT, 45 mg OD; venlafaxine XR, 225 mg OD) were reached by day 6 of treatment. On the primary efficacy parameter [the average of the change in HAM-D (17-item) total score on days 5, 8, 11, and 15], mirtazapine ODT was significantly superior to venlafaxine XR (P = 0.008). In addition, calculating the HAM-D score without the sleep items resulted in significant reductions in favor of mirtazapine ODT on days 8 (P = 0.006) and 11 (P = 0.037). The proportion of responders (HAM-D decrease of > or =50% from baseline) was higher in the mirtazapine ODT group on all assessment days, being significant on days 8 (P = 0.002), 11 (P = 0.004), and 22 (P = 0.027). More patients in the mirtazapine ODT group achieved remission (HAM-D total score of < or =7) up to day 29, and the difference was statistically significant on day 15 (P = 0.016). Significant differences in favor of mirtazapine ODT were evident in the CGI of change on days 8 (P = 0.019), 11 (P = 0.004), and 15 (P = 0.031), and the CGI of severity on days 8 (P = 0.014) and 11 (P = 0.033). Both treatments were well tolerated. These results indicate that mirtazapine ODT has a faster onset of antidepressant efficacy than venlafaxine XR in patients with major depressive disorder, and that this effect is independent of its sleep-improving properties.     

博乐欣与阿米替林治疗门诊抑郁症患者对照研究

目的比较博乐欣（文拉法辛）与阿米替林治疗门诊抑郁症的临床疗效和不良反应。方法对63例抑郁症患者随机分为两组,分别给予博乐欣和阿米替林治疗8周。采用汉密尔顿抑郁量表（HAMD）、药物不良反应量表（TESS）进行评临床疗效评定不良反应。结果博乐欣与阿米替林嗪显效率差异有显著性,博乐欣组显效快,不良反应少。结论博乐欣是一种安全有效的抗抑郁剂。