文拉法辛与选择性5-羟色胺再摄取抑制剂治疗抑郁症引发失眠、焦虑、激越与躁狂的Meta分析

目的分析文拉法辛与选择性5-羟色胺再摄取抑制剂(SSRIs)治疗抑郁症引发失眠、焦虑、激越与躁狂的差异。方法应用循证医学的Meta分析,采用固定效应模型(fixed effects model,FEM)法对符合标准的26项对照研究文献进行评价。结果文拉法辛与SSRIs治疗抑郁症出现失眠(12.70%V12.55%)差异没有显著性(P>0.05),但是焦虑(4.62%V13.08%)、激越(8.54%V4.8%)以及躁狂发作(5.21%V1.82%)的差异均有显著性(P<0.05~0.01)),OR分别是0.31,2.15和2.98。结论在治疗抑郁症中,文拉法辛与SSRI均可引发失眠、焦虑、激越与躁狂发作,特别需要注意SSRI可能引发的焦虑和文拉法辛可能引发的激越与躁狂发作。     

喹硫平与SSRIs治疗难治性抑郁症对照研究

目的 探讨喹硫平与SSRIs合用与SSRIs治疗难治性抑郁症的临床疗效及安全性.方法 将80例难治性抑郁症患者随机分为两组各40例,研究组口服喹硫平与SSRIs治疗,对照组口服SSRIs药物治疗.观察9个月,于治疗前及治疗1,3,6,9个月.束采用汉密尔顿抑郁量表和副反应量表评定临床疗效和不良反应,生存质量量表评定患者的生存质量.结果 治疗9个月末,研究组有效率90.0%,对照组为72.5%,研究组显著高于对照组（x2=4.02,P＜0.05）.结论 喹硫平对难治性抑郁症疗效肯定,能显著改善患者的生存质量.     

SSRIs抗抑郁治疗的起效时间对疗效的影响

研究SSRIs在抗抑郁治疗的起效时间对治疗结局有无影响。方法对152例应用SSRIs抗抑郁治疗的患者进行调查。所有患者均符合ICD-10F32抑郁发作的诊断标准,用汉密尔顿抑郁量表（HAMD）评定疗效,根据治疗2周后HAMD减分率是否大于25%将患者分为早期治疗起效组和早期治疗无效组,随访观察治疗结局。结果早期治疗起效组临床痊愈率（51.1%）高于早期治疗无效组（30.6%）;早期治疗起效组平均住院时间为（33.5±12.3）天,短于早期治疗无效组（64.3±15.4）天,差异均有统计学意义。结论 SSRIs抗抑郁治疗早期起效可明显提高治愈率及缩短住院时间。     

SSRIs在儿童及青少年精神障碍中的应用

目的：了解选择性5—羟色胺回收抑制剂(SSRI)类在儿童及青少年精神障碍中的应用。方法：对儿童精神科门诊使用SSRIs的75例患者进行回顾性分析。结果：SSRIs已广泛应用于治疗多种儿童及青少年精神障碍。结论：SSRIs对部分儿童及青少年精神障碍疗效较好，安全性高。     

SSRIs类药物治疗儿童少年情绪障碍229例疗效观察

目的 了解SSRIs类药物在儿童少年情绪障碍治疗中的疗效与副反应。方法 自制调查表,回顾分析229例应用SSRIs类药物治疗儿童少年情绪障碍的各项资料。结果 药物平均起效时间16.6天。平均有效剂量:舍曲林30.8 mg,氟西汀与帕罗西汀均接近于20 mg。总有效率62.9％(脱落32.8％),副作用发生率11.8％(脱落18.5％)。结论 SSRIs类药物起效时间仍未短于2周,疗效与环类抗抑郁剂不相上下,而服用方便,副作用轻,在治疗儿童情绪障碍中前景广阔。     

东菱精纯克栓酶(DF—521)治疗脑梗塞并发出血8例报告

我们统计了我院急诊科和神经科一年来应用东菱精纯克栓酶(DF—521)治疗急性脑梗塞60例,其中8例并发出血,7例脑内出血,1例脑外出血,(男5例,女3例,年龄24～90岁)。8例中5例为大面积脑梗塞;5例合并高血症;4例在发病6小时后用药;3例合并应用抗血小板凝集药物。提示在应用DF—521治疗急性脑梗塞时下列情况需慎重应用:①大面积脑梗塞;②伴脑出血危险因素如高血压;③高龄;④梗塞时间较长及合并应用其它抗血小板凝集药物。     

强迫症患者前瞻记忆缺损程度对SSRIs疗效的预测作用

目的 探究强迫症患者前瞻记忆缺损程度对选择性5-羟色胺再摄取抑制剂(SSRIs)疗效的预测作用.方法 选择符合《精神障碍诊断与统计手册(第4版)》修订版(DSM-IV-TR)强迫症诊断标准的30例强迫症患者为研究对象,对患者进行为期4周的SSRIs药物治疗.采用耶鲁布朗强迫症状量表(Y-BOCS)评定患者治疗前后强迫症...     

Serotonin syndrome induced by a combination of bupropion and SSRIs

Serotonin syndrome (SS) is a potentially fatal complication of the combined use of agents that enhance serotonin activity. Bupropion inhibits noradrenaline and dopamine reuptake with milder effects on serotonergic activity. Although regarded as a potential causative agent for SS, no cases have been reported in the medical literature. A 62-year-old woman treated with therapeutic dosages of bupropion and sertraline for depression for the previous 3 weeks presented with upper extremity myoclonic jerks, clumsiness, and gait difficulties with fluctuating symptoms of confusion, forgetfulness, and the alternation of agitation and lethargy. Symptoms were interpreted as an aggravation of depression and venlafaxine was added. The clinical picture progressed to alteration of consciousness and dysautonomia. After admission, medications were discontinued and she was started on cyproheptadine and clonazepam with gradual improvement and complete resolution of symptoms. This is a rare report of SS related to the association of bupropion and selective serotonin reuptake inhibitors (SSRIs). It also illustrates the potential for misinterpretation of the earliest manifestations of SS as signs of aggravation of the patient's underlying condition. The role of bupropion in SS is possibly related to its well-established specific inhibition of the cytochrome P450 2D6 pathway, increasing blood levels of SSRIs and tricyclic antidepressants.     

Shock priming enhances the efficacy of SSRIs in the foot shock-induced ultrasonic vocalization test

Data on the effect of acutely administered serotonin reuptake inhibitors (SSRIs) in animal anxiety models have been inconsistent. In some of the models these compounds showed anxiolytic properties, while in others they were ineffective or even anxiogenic. In the foot shock-induced ultrasonic vocalization (USV) test in the adult rat, SSRIs were reported to be effective, however, they were only tested with protocols using multiple shocking design. In the present study, anxiolytic effects of various SSRI compounds (sertraline, fluoxetine, paroxetine, escitalopram) were tested in three distinct USV test protocols in comparison with alprazolam and 8-OH-DPAT. In the single shocking protocol, animals were exposed to one shocking session after the drug treatment. In the multiple shocking protocol, rats went through a foot shock priming session before each drug test. On priming days animals received foot shocks without drug treatment. On the test day (the day after), rats received drug treatment and then were shocked again. In the context conditioning protocol animals were exposed to foot shocks on two consecutive days before the drug test. On the third, test day, after drug treatment animals were replaced to the shocking chamber, but this time shocks were not delivered. SSRIs were ineffective using the single shocking protocol. In the context conditioned protocol, all SSRIs showed linear dose-response relationship with ED₅₀ values of 8.5, 2.2, 0.77 and 0.93 mg/kg i.p. for fluoxetine, sertraline, paroxetine and escitalopram, respectively. Using the multiple shocking protocol, SSRIs were only partially effective with maximum inhibitions ranging between 44% and 62%. In contrast to SSRIs, the benzodiazepine anxiolytics, alprazolam showed anxiolytic activity with linear dose-response relationship in all of the test protocols, with ED₅₀ values varying from 1.3 to 4.0 mg/kg i.p. The serotonin 5HT_1A receptor antagonist 8-OH-DPAT also showed linear dose-response relationship in all protocols, but this compound was less potent in the single shocking design (ED₅₀ values were 0.27, 0.04 and 0.07 mg/kg i.p. in the single shocking, multiple shocking and context conditioned protocol, respectively). In conclusion, our results show that priming has a major impact on the effectiveness of SSRIs in the USV test, and the three test protocols applied in this study have different predictive and face validity.     

Bleeding time is prolonged during oral anticoagulant therapy

We have performed the BT test in 55 patients undergoing oral anticoagulant therapy monitored by means of Thrombotest (TT). Patients in steady state of anticoagulation showed longer BT than normal controls; patients in overdose phase had longer BT values than either controls or patients in steady state. After recovery the overdose phase patients showed BT values not different from those of the controls. Moreover we were able to find in our patients a significant linear correlation between BT and TT. Impairment in primary haemostasis could be due either to a scarce fibrin deposition in the haemostatic plug or to deficiency of a possible vitamin K dependent vascular “bleeding factor”.     

A benzisothiazole derivative and antipsychotic agent,perospirone, for augmentation of selective serotonin reuptake inhibitors (SSRIs) in refractory obsessive-compulsive disorder (OCD): two patient case series

Even though selective serotonin reuptake inhibitors (SSRIs) are the mainstay of pharamacological treatment for obsessive-compulsive disorder (OCD), as many as 40% of patients do not have an adequate response to these medications. For such SSRI-refractory patients, the augmentation of SSRIs with new-generation antipsychotics that modulate both 5-HT and DA systems has recently been proven effective in controlled augmentation studies. The benzisothiazole derivative perospirone is a new serotonin 5-HT2 and dopamine D2 antagonist available in Japan for the treatment of schizophrenia. As its unique property, perospirone also exhibits 5-HT1A agonistic action. We present two SSRI-refractory OCD patients who showed little improvement with adequate trials of SSRI monotherapy, but exhibited significant improvement in their OCD symptoms after the addition of perospirone to ongoing SSRI treatment. The cases suggest that perospirone augmentation may be an effective and well-tolerated strategy for SSRI-refractory OCD patients. Controlled studies are required to further confirm the efficacy and tolerability of perospirone augmentation for treatment-resistant OCD.     

SSRIs对首发抑郁症患者社会功能的改善作用

目的 评价同一临床治疗模式下,SSRIs对首发抑郁症患者社会功能的改善作用.方法 对符合要求的124例首发抑郁症患者,接受患者教育课程后随机给予4种SSRIs抗抑郁药物,分别在治疗前及治疗后第6、12周末采用汉密尔顿抑郁量表(HAMD)进行症状评估、WSAS和SF-12量表进行社会功能评估.结果 共有81例患者完成整个随访研究,其中79例达到有效标准,76例达到临床治愈标准,无效2例.SF-12评分较治疗前PF、RP、SF、RE维度得分显著升高,BP、GH、VT维度得分显著下降,总分、PCS和MCS显著升高,其差异均具有统计学意义(P均＜0.05).WSAS各条目分和总分评分治疗前后差异均有统计学意义(P均＜0.05).结论 在同一临床治疗模式下,临床一线SSRIs治疗首发抑郁症,临床疗效显著,社会功能方面,除SF-12评分中BP、GH、VT三个维度外,总的来说随着治疗时间的延长逐渐改善,有利于患者适应社会.     

SSRIs and conditioned fear

Among drugs that act on serotonergic neurotransmission, selective serotonin (5-HT) reuptake inhibitors (SSRIs) are now the gold standard for the treatment of anxiety disorders. The precise mechanisms of the anxiolytic actions of SSRIs are unclear. We reviewed the literature related to the effects of SSRIs and the neurochemical changes of 5-HT in conditioned fear. Acute SSRIs and 5-HT_1A receptor agonists reduced the acquisition and expression of contextual conditioned fear. Chronic SSRI administration enhanced anxiolytic-like effects. Microinjection studies revealed the amygdala as the target brain region of both classes of serotonergic drugs, and the hippocampus as the target of 5-HT_1A receptor agonists. These findings highlight the contribution of post-synaptic 5-HT receptors, especially 5-HT_1A receptors, to the anxiolytic-like effects of serotonergic drugs. These results support the new 5-HT hypothesis of fear/anxiety: the facilitation of 5-HT neurotransmission ameliorates fear/anxiety. Furthermore, these behavioral data provide a new explanation of neurochemical adaptations to contextual conditioned fear: increased 5-HT transmission seems to decrease, not increase, fear.     

Differential effectiveness of newer and older antidepressants appears mediated by an age effect on the phenotypic expression of depression

OBJECTIVE: A possible mechanism whereby the serotonin reuptake inhibitor (SSRI) antidepressants may not (overall) be as effective as the tricyclic (TCA) antidepressants is explored. METHOD: Clinical psychiatrists rated the effectiveness of past antidepressant medications in a clinical panel study of patients with a major depressive disorder, with 200 having previously received a TCA and 219 an SSRI. RESULTS: Analyses indicated decreased SSRI effectiveness with age in those with the melancholic subtype. TCA effectiveness appeared uninfluenced by age and depressive subtype. CONCLUSION: Findings suggest why the broader-based TCAs may be more effective than the SSRIs in implicating age and depressive subtype influences.     

奎硫平治疗抑郁发作的对照研究

目的:探讨奎硫平对抑郁发作的疗效和安全性。方法:收集抑郁发作或复发性抑郁的患者60例,分为奎硫平组和5-羟色胺再摄取抑制剂(SSRIs)组各30例,疗程8周。使用Montgomery-As-berg抑郁量表(MADRS)、汉密尔顿抑郁量表(HAMD)和汉密尔顿焦虑量表(HAMA)评定疗效,以治疗中出现的症状量表(TESS)评定不良反应。结果:治疗8周两组MADRS、HAMD和HAMA量表减分值相仿(P均>0.05),治疗1周末奎硫平组即显示疗效优于SSRIs组(P均<0.05);奎硫平组MADRS量表失眠障碍因子减分值大。治疗8周奎硫平组有效率为25例(83.3%),SSRIs组为26例(86.7%)。奎硫平组无转躁患者,而SSRIs组转躁3例。奎硫平组头晕、口干、便秘的发生率明显多于SSRIs组。结论:奎硫平单药治疗抑郁发作的疗效与SSRIs相当,可改善患者失眠和焦虑症状,头晕、口干、便秘等不良反应较多见。