氟西汀早期干预卒中后抑郁的临床研究

目的观察卒中后抑郁的发生率以及氟西汀早期治疗对卒中后抑郁的干预作用及对神经功能康复的影响。方法选取2005-01～2005-04住院的脑卒中患者66例,随机分为氟西汀治疗组和常规治疗组,常规治疗组仅给神经内科常规治疗,氟西汀治疗组在常规治疗1周后加用氟西汀口服4周。对2组病人均在病程的1周及5周时采用汉密尔顿抑郁量表（HAMD）、日常生活能力量表（ADL）、神经功能缺损评分标准（SSS）进行评定。结果卒中后抑郁发生率为38.24%,治疗后氟西汀治疗组HAMD抑郁评分低于常规治疗组（P〈0.05）,2组患者SSS,ADL分值均有好转,在好转程度上,氟西汀治疗较常规治疗明显（P〈0.05）。结论卒中急性期卒中后抑郁发生率高;早期应用氟西汀治疗可减轻PSD症状、促进神经功能康复。     

氟西汀治疗脑卒中后抑郁的疗效观察

目的探讨氟西汀治疗卒中后抑郁的临床疗效和安全性。方法将108例卒中后抑郁患者随机分为对照组(54例)和治疗组(54例),对照组按脑卒中临床路径治疗;治疗组在此基础上加用氟西汀20mg/次,1次/d,早晨后服用,均为2周一疗程;治疗前后对疗效进行评价。结果治疗组总体评价的痊愈率和有效率显著高于对照组,差异有统计学意义(P0.05)。结论氟西汀是一种疗效好、不良反应少、安全性高、价格低廉的抗抑郁药,值得临床应用。     

氟西汀联合心理治疗卒中后抑郁患者54例临床分析

本文对54例脑卒中患者氟西汀联合心理治疗,现报告如下。     

养血清脑颗粒治疗卒中后抑郁的疗效及对脑白质结构改变的影响

目的利用磁共振弥散张量成像(DTI)技术,观察养血清脑颗粒治疗卒中后抑郁(PSD)的疗效差异,以及其对脑白质结构改变的影响。方法给予卒中后抑郁患者养血清脑颗粒4 g,口服,3次/d;疗程12 w,治疗前、后均收集汉密尔顿抑郁量表评分(HAMD-24)、DTI扫描数据。治疗后HAMD-24≤8分纳入治愈组,反之纳入难治组。比较两组治疗前、后FA值变化情况。结果养血清脑颗粒治愈率约44.6%。与治疗前相比,治愈组的左侧额叶FA值治疗后明显升高(P0.05);比较两组治疗前的FA值,发现难治组左侧额叶、右侧海马的基线FA值低下(P0.05)。结论养血清脑颗粒治疗PSD有效。PSD患者存在可逆性前额叶深部白质损伤;且难治性PSD患者左侧额叶、右侧海马的基线FA值低下,提示DTI可作为抗抑郁疗效评估的预测指标。     

脑梗死抑郁应用盐酸氟西汀的作用分析

目的 分析脑梗死抑郁应用盐酸氟西汀的治疗效果。方法 随机选择于2013年6月～2015年5月本院收治的脑梗死抑郁患者80例作为本研究对象,采用电脑随机分组方式将此次收治于本院的患者随机分为研究组与常规组,2组各40例; 其中常规组患者给予神经内科常规治疗方案; 研究组患者给予神经内科常规治疗加盐酸氟西汀治疗方案,使用神经功能缺损评分量表、HAMD(汉密尔顿抑郁)量表评价患者神经功能恢复情况以及抑郁改善状况,并观察2组患者用药的不良反应。结果 研究组患者神经功能恢复总效率达到85%、抑郁恢复达到70%; 常规组患者神经功能恢复总效率达到了67.5%、抑郁恢复达到45%; 研究组的治疗效果显著优于常规组(P<0.05)。结论 针对脑梗死抑郁患者予以盐酸氟西汀进行治疗,其临床效果十分显著,疗效满意,即可显著改善患者抑郁状态,提升患者生活质量以及生活活动能力。     

氟西汀对卒中后抑郁大鼠海马组织细胞因子的干预作用

目的观察卒中后抑郁(post-stroke depression,PSD)模型大鼠海马组织细胞因子的表达及氟西汀干预作用。方法选用健康雄性SD(Sprague-Dawley,SD)大鼠,随机分为5组,假手术组、单纯缺血组、单纯抑郁组、PSD组、氟西汀干预组。进行行为学观察和测试、脑梗死体积测定、免疫组化法测定海马组织TNF-α、IL-1、IL-6的表达及含量。结果与假手术组比较,其余各组大鼠海马组织TNF-α、IL-1含量不同程度增高而IL-6含量则减少,HE染色示海马神经细胞受损;与单纯缺血组比较,PSD组大鼠海马组织TNF-α、IL-1含量明显增高而IL-6含量则明显减少(P0.01),HE染色示海马神经细胞受损明显;与PSD组比较,氟西汀能不同程度减少TNF-α、IL-1含量而提高IL-6的含量(P0.01)。结论大鼠PSD可能与细胞因子网络失衡有关,氟西汀干预后致炎性细胞因子和抗炎性细胞因子表达的变化,可能有助于阐明卒中后抑郁症的发病机制。     

养血清脑颗粒治疗脑卒中后抑郁疗效观察

脑卒中后抑郁(poststroke depression,PSD)是脑卒中后最常见的精神障碍,是以持续性情感低落、兴趣减退为特征的心境障碍。约15%的重度抑郁患者伴有严重自杀倾向,甚至自杀行为。它影响着脑卒中存活者的认知和神经功能的恢复[1],增加脑卒中患者的病死率[2]。近年来常用5-羟色胺选择性抑制剂氟西汀(百忧解)治疗卒中后抑郁,但常出现失眠、困倦、疲劳、震颤、多汗、厌食、恶心、腹泻、头晕等不良反应。我院2006-12～2009-09用养血清脑颗粒治疗112例     

盐酸氟西汀治疗脑卒中后抑郁的系统评价

目的评价盐酸氟西汀治疗脑卒中后抑郁的效果。方法计算机检索中国期刊全文数据库,维普期刊,万方数据库及Medline(1950～2010)、EMbase(1948～2010)、SCIE中关于盐酸氟西汀治疗脑卒中后抑郁的随机对照试验,同时按照制定的纳入标准收集分析文献。从224篇文章中选出9项随机对照试验。对其进行Meta分析。结果显示盐酸氟西汀较对照组治疗脑卒中后抑郁有明显疗效。与对照组比较,盐酸氟西汀可明显降低汉密尔顿抑郁量表分值(p=0.001,WMD-5.27,95%CI(-8.47～-2.07)。结论盐酸氟西汀是治疗卒中后抑郁的一种有效的药物。     

氟西汀治疗脑卒中抑郁的临床研究

抑郁是脑卒中后常见的并发症之一，严重影响患者的生活质量及预后，已日益引起人们的关注。笔者应用氟西汀(百忧解)治疗脑卒中后抑郁(poststroke depression，PSD)，取得了较为满意的疗效。     

A Double-Blind Study of Paroxetine, Fluoxetine, and Placebo an Outpatients with Major Depression

We report results from a multicenter, placebo-controlled, randomized, double-blind comparison of the efficacy and tolerability of paroxetine and fluoxetine in outpatients with major depression. Across five U.S. sites, 128 outpatients (mean age: 41.3 ± 12.6; 63 men and 65 women) with moderate to moderately severe major depression without a history of mania or hypomania were recruited between 1993 and 1994. All 128 patients completed a 1-week placebo washout period, and were then randomized to 12 weeks of double-blind treatment with paroxetine up to 50 mg/day (n = 55), fluoxetine up to 80 mg/day (n = 54), or placebo (n = 19). Subjects were evaluated weekly for the first 4 weeks, then at weeks 6, 9, and 12 with the 21-item HAMD and the Covi Anxiety Scale. There were no significant differences among the three treatment groups in baseline and endpoint depression and anxiety severity, as well as in the degree of depression and anxiety improvement. There were no statistically significant differences in rates or mean numbers of adverse events between paroxetine-treated patients and fluoxetine-treated patients. In summary, our results, although limited by the lack of a significant difference from placebo in treatment outcome, suggest that the SSRIs paroxetine and fluoxetine have comparable antidepressant and antianxiety efficacies among depressed outpatients, as well as similar safety and tolerability profiles.     

卒中后抑郁的发病机制研究进展

卒中后抑郁（post-stroke depression,PSD）是卒中的常见并发症。PSD的发病机制复杂,涉及神经生物学、解剖学、社会学和心理学等诸多因素。本文对以神经递质学及神经解剖学改变为代表的机制学说的研究进展做一综述,以期加深对PSD的理解和认识。     

盐酸舍曲林预防性治疗卒中后抑郁的多中心研究

目的 探讨缺血性卒中后早期应用盐酸舍曲林对卒中后抑郁（post-stroke depression,PSD）和认知功能障碍的影响。      

卒中后抑郁细胞因子蛋白组学初探

目的 初步探讨急性缺血性卒中患者血浆120种细胞因子蛋白水平与卒中后抑郁（post-stroke depression,PSD）发生的关系。 方法 入组PSD及非PSD患者各12例,均为卒中发生后3 d内入院的急性缺血性卒中患者,随访至卒中后 2周,对患者进行神经功能,认知功能及抑郁、焦虑严重程度评估。患者入院后1 d［卒中后（1.5±0.9） d］清晨6∶30留取空腹时静脉血浆标本,利用人类细胞因子蛋白表达微阵列芯片进行120种细胞因子 蛋白组学检测。 结果 与非PSD组相比,PSD组4个细胞因子血浆中点信号强度（spot signal intensity,SIs）显示降 低,差异有显著性,分别为胰岛素样生长因子1受体（insulin-like growth factor 1 receptor, IGF-I S R）（P =0.021）,巨噬细胞炎症蛋白-3β（macrophage inflammatory protein-3 beta,MIP-3 beta） （P =0.033）,胎盘生长因子（placental growth factor,PIGF）（P =0.021）,血管内皮生长因子（vascular endothelial growth factor,VEGF）（P =0.015）,但均未通过错误发现率多重校正,多因素Logi sti c回归分 析无阳性发现。血浆胰岛素样生长因子1受体蛋白SIs与患者入院时Barthel指数呈负相关（r =－0.641, P =0.025）,与2周后PSD患者汉密尔顿抑郁量表评分（r =0.478,P =0.005）及汉密尔顿焦虑量表评分 （r =0.674,P =0.016）呈正相关。 结论 本研究的数据尚未发现能独立预测卒中急性期PSD风险的血浆细胞因子,但3种生长因子水 平的异常提示PSD可能存在突触可塑及神经再生障碍。     

Quality of Life Impacts of Bright Light Treatment,Fluoxetine, and the Combination in Patients with Nonseasonal Major Depressive Disorder: A Randomized Clinical Trial

Objective:Bright light therapy is increasingly recommended (alone or in combination with antidepressant medication) to treat symptoms of nonseasonal major depressive disorder (MDD). However, little is known about its impacts on quality of life (QoL), a holistic, patient-valued outcome.Methods:This study utilizes secondary outcome data from an 8-week randomized, controlled, double blind trial comparing light monotherapy (n = 32), fluoxetine monotherapy (n = 30), and the combination of these (n = 27) to placebo (n = 30). QoL was assessed using the Quality of Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF). Treatment-related differences in QoL improvements were assessed using a repeated measures analysis of variance. The influence of potential predictors of QoL (demographic variables and change in depressive symptoms) were investigated via hierarchical linear regression.Results:Q-LES-Q-SF scores significantly improved across all treatment conditions; however, no significant differences were observed between treatment arms. QoL remained poor relative to community norms by the end of the trial period: Across conditions, 70.6% of participants had significantly impaired QoL at the 8-week assessment. Reduction in depressive scores was a significant predictor of improved QoL, with the final model accounting for 54% of variance in QoL change scores.Conclusion:The findings of this study emphasize that improvement in QoL and reduction in depressive symptoms in MDD, while related, cannot be taken to be synonymous. Adjunctive therapies may be required to address unmet QoL needs in patients with MDD receiving antidepressant or light therapies. Further research is required to explore additional predictors of QoL in order to better refine treatments for MDD.     

舍曲林治疗老年脑卒中后抑郁的前瞻性临床随机对照研究

目的:探讨舍曲林治疗老年卒中后抑郁(PSD)的疗效和对卒中康复的影响。方法:老年PSD病人随机入选治疗组、对照组各65例,卒中均经临床、影像诊断、规范治疗5个月内,抑郁诊断为Zung量表≥40分或GDS量表5~10分。治疗组加用舍曲林治疗共12周。观察两组病人的抑郁量表和ADL评分。结果:抑郁量表和ADL评价发现治疗组总体疗效优于对照组,治疗组在治疗后4、8和12周末均有逐步好转,抑郁量表评价亚组分析提示治疗组左半球、多灶病人抑郁症状较明显,其疗效更好,而ADL评定亚组分析提示治疗组左半球、单灶病人的康复效果更佳。结论:舍曲林治疗老年PSD有效,也促进卒中康复。     

Effects of Fluoxetine on Poststroke Dysphagia: A Clinical Retrospective Study

Background

To investigate whether fluoxetine improves poststroke dysphagia and to detect the potential relationship between serum brain-derived neurotrophic factor (BDNF) levels and fluoxetine effects.

Fluoxetine in child and adolescent depression: Acute and maintenance treatment

The objective was to present naturalistic 1-year follow-up information of 96 child and adolescent outpatients with major depressive disorder who had been randomized in an 8-week double-blind, placebo-controlled trial of fluoxetine. Subjects were children and adolescents, ages 8-18 years, who were entered in a randomized clinical trial of fluoxetine. Following the acute treatment trial, treatment was not controlled. At 6 months and 1 year, the subjects and parents were interviewed using the Kiddie Longitudinal Interval Follow-up Evaluation (K-LIFE) for course of depression. Eighty-seven of the 96 subjects were followed for 1 year. Of these, 74 (85%) recovered from the depressive episode during that time (47 on fluoxetine, 22 on no medication, and 5 on other antidepressants or lithium). Twenty-nine of the subjects (39%) who recovered had a recurrence of depression during the 1-year follow-up, with 55% of these occurring within 6 months. Results of this study are similar to adult studies, with respect to response and recovery of depressive episodes. Most patients (85%) recover from the episode within 1 year, but approximately 40% have a recurrence within 12 months, which is a higher recurrence rate than in adults. Recovery was associated with younger age, lower severity of depressive symptoms, higher family functioning, and fewer comorbid diagnoses. Recurrence, which occurs both on and off medication, was difficult to predict, as there was little clinical data associated with recurrence in this population. Depression and Anxiety 7:32–39, 1998. © 1998 Wiley-Liss, Inc.     

Hostility in heroin abusers subtypes: Fluoxetine and naltrexone treatment

Gerra Gilberto, Giuseppe Fertonani, Amir Zaimovic, Ines Rota-Graziosi, Paola Avanzini, Rocco Caccavari, Roberto Delsignore and Alfio Lucchini: Hostility in Substance Abusers Subtypes: Fluoxetine and Naltrexone Treatment. Prog. Neuropsychopharmacol. & and Biol. Psychiat. 1995, 19(8): 1225–1237.

1. 1. Substance abusers subtypes have been identified considering underlying psychobiological disorder, familial factors, age of onset, legal problems and drug of choice.

2. 2. In the present study the authors submitted 98 male heroin addicted individuals (age 19–28 y) to the Buss Durkee Hostility Inventory (Italian version) and a structured interview concerning social and clinical history; legal problems, age of onset of drug abuse, drug of choice.

3. 3. Serotonergic system sensitivity was evaluated with fenfluramine challenge for PRL assay.

4. 4. Thirty two patients (group A) showed high score for resentment and guilt at BDHI (hostility in), low rate of legal problems, late age of onset, preference for heroin and alcohol. Twenty nine patients (group B) showed high score for assault and irritability at BDHI (hostility out), high rate of legal problems, early age of onset, preference for heroin and cocaine. The other 37 patients (group C) showed aggression score in the normal range at BDHI, no legal problems, late onset of substance abuse, preference for heroin only.

5. 5. PRL responses was blunted in group A (p < 0.001) and significantly decreased in group B (p < 0.05). PRL plasma levels were inversely correlated with HRSD scores.

6. 6. All the patients were included in a treatment protocol with fluoxetine and naltrexone or placebo and naltrexone for 6 months.

7. 7. The treatment was effective in group A with a significant improvement of BDHI results and decrease of craving score, lower level of drop out, lower level of positive urine controls. No significant differences between fluoxetine and placebo effects have been evidenced in patients of group B and C. The present findings suggest that psychopharmacological approach to addiction needs a diagnostic screening for specific subtypes.