艾司西酞普兰与氟西汀治疗老年抑郁症的疗效与安全性对比观察

目的对比分析艾司西酞普兰与氟西汀治疗老年抑郁症的临床疗效与安全性,探讨老年抑郁症的合理治疗方法。方法将确诊为抑郁症的104例老年患者随机分为艾司西酞普兰组和氟西汀组,每组各52例,分别进行2个月的治疗,治疗前及治疗后2、4、8周进行汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、不良反应量表(TESS)评定两种药物的临床疗效与安全性。结果艾司西酞普兰组的总有效率为92.16%,氟西汀组的总有效率为82.15%,两组疗效比较差异无统计学意义(P>0.05);艾司西酞普兰组和氟西汀组的患者在治疗2周后的HAMD和HAMA评分差异有统计学意义,艾司西酞普兰组明显低于氟西汀组;而且艾司西酞普兰组治疗4、6周后HAMD评分也明显低于氟西汀组;氟西汀组出现乏力、便秘、恶心比例明显高于艾司西酞普兰组,差异有统计学意义。结论艾司西酞普兰较氟西汀更适合于老年期抑郁的治疗,抑郁和焦虑症状评分改善的时间更早,且安全性更好,可作为治疗老年抑郁症的首选药物。     

艾司西酞普兰与氟西汀治疗抑郁症疗效观察

目的：探讨艾司西酞普兰与氟西汀治疗抑郁症的疗效和安全性。方法：将110例抑郁症患者随机分为艾司西酞普兰组与氟西汀组,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：艾司西酞普兰组与氟西汀组总体疗效相当,艾司西酞普兰起效快,不良反应较轻。结论：艾司西酞普兰治疗抑郁症既有效又安全。     

艾司西酞普兰与氟西汀治疗抑郁症对照研究

目的:比较艾司西酞普兰与氟西汀治疗抑郁症的疗效和安全性。方法:77例抑郁症发作的门诊患者随机分为艾司西酞普兰组(39例)与氟西汀组(38例),分别给予艾司西酞普兰10～20mg、盐酸西汀20～40mg治疗,每日1次,疗程6周。疗效采用汉密尔顿抑郁量表(HAMD)评定,不良反应和安全性用副反应量表(TESS)和实验室检查评定。结果:艾司西酞普兰组有效率87.2%,痊愈率48.7%,氟西汀组有效率86.8%,痊愈率47.4%,2组疗效差异无统计学意义(P>0.05)。但第1周末和第2周末HAMD评分2组差异有统计学意义(P<0.01或P<0.05);艾司西酞普兰组不良反应发生率为17.9%,明显少于氟西汀组的26.3%(P<0.05)。结论:艾司西酞普兰起效快,不良反应小,安全性好,可作为一线抗抑郁药。     

艾司西酞普兰与氟西汀治疗老年抑郁症的临床疗效比较

目的探讨艾司西酞普兰对老年抑郁症患者的疗效和安全性。方法将60例符合CCMD-3抑郁发作的老年抑郁症患者随机分为艾司西酞普兰组（艾司西酞普兰10—20mg·d^-1）和氟西汀组（氟西汀20—40mg·d^-1）,疗效采用汉密尔顿抑郁量表（啪）评定,不良反应和安全性用TESS和实验室检查评定。共观察6周。结果艾司西酞普兰组显效率和治愈率分别为70．4％和44．5％,氟西汀组为69．2％和42．3％,两组比较差异无统计学意义。但艾司西酞普兰组在l周末Hh／VID评分与治疗前比较即有明显下降,且2组间差异有统计学意义（P〈0．05）。艾司西酞普兰组主要不良反应有食欲下降、恶心、头晕各3例次（10％）,失眠、口干、心悸各2例次（6．7％）,便秘、嗜睡各1例次（3．3％）,与氟西汀组相比无统计学意义。结论艾司西酞普兰治疗老年抑郁症患者显效快,疗效和不良反应与氟西汀相似。     

艾司西酞普兰与氟西汀治疗抑郁症对照研究

目的比较艾司西酞普兰与氟西汀治疗抑郁症的疗效和安全性。方法随机将77例符合CCMD-3抑郁发作的住院患者分为艾司西酞普兰组和氟西汀组,艾司西酞普兰组剂量10～20mg／d,氟西汀组20～40mg／d,疗程6周。疗效采取汉密尔顿抑郁量表（HAMD）和汉密尔顿焦虑量表（HAMA）评定,不良反应和安全性用TESS和实验室检查评定。结果两组总体疗效相当,艾司西酞普兰组有效率为87．2％,治愈率为48．7％,氟西汀组有效率为86．8％,治愈率4为7．4％,两组疗效比较差异无显著性。但1周末时HAMD评分及减分率两组间差异有显著性,说明艾司西酞普兰起效快;艾司西酞普兰组不良反应发生率明显少于氟西汀组,差异有统计学意义。结论艾司西酞普兰是安全、有效的抗抑郁药。     

艾司西酞普兰与帕罗西汀治疗老年抑郁症对照研究

目的评价艾司西酞普兰与帕罗西汀治疗老年抑郁症的临床疗效及安全性。方法将64例老年抑郁症患者随机分为艾司西酞普兰组32例,帕罗西汀组32例,观察6周。于治疗前和治疗1周、2周、4周、6周末采用汉密顿抑郁量表（HAMD）评定疗效,副反应量表（TESS）评定不良反应。结果艾司西酞普兰组显效率78.1%,帕罗西汀组75%,两组比较差异无显著性（P〉0.05）;治疗第2周末艾司西酞普兰组汉密顿抑郁量表评分（HAMD）显著低于帕罗西汀组（P〈0.05）。1周、4周、6周末两组评分比较差异无显著性（P〉0.05）;艾司西酞普兰组不良反应发生率40.6%,帕罗西汀组43.8%,两组比较差异无显著性（P〉0.05）。结论艾司西酞普兰与帕罗西汀治疗老年抑郁症具有同等疗效,但艾司西酞普兰起效较帕罗西汀快。     

艾司西酞普兰与氟西汀治疗老年抑郁症疗效对照研究

目的 比较艾司西酞普兰与氟西汀治疗老年抑郁症的疗效和安全性.方法 将70例老年抑郁症患者随机分为观察组和对照组各35例.观察组给予艾司西酞普兰治疗,对照组给予氟西汀治疗.用汉密顿抑郁量表（HAMD）评定其疗效,采用副反应量表评价安全性,分别在治疗0、1、2、4、6周末评定疗效和不良反应.结果 观察组痊愈率为68.57%高于对照组的65.71%,有效率为82.86%高于对照组的80.00%,但2组差异无统计学意义（P〉0 05）.HAMD评分2组治疗第1、2、6周均低于治疗前,观察组治疗第1周HAMD总分和睡眠障碍因子分值低于对照组,差异有统计学意义（P〈0.05）.2组不良反应的发生率比较差异无统计学意义（P〉0.05）.结论 艾司西酞普兰治疗老年抑郁症有效且安全,且起效时间早于氟西汀.     

艾司西酞普兰与氟西汀治疗抑郁症的临床分析

目的:观察艾司西酞普兰与氟西汀治疗抑郁症的效果及安全性。方法:将71例抑郁症患者随机分为艾司西酞普兰组(35例)和氟西汀组(36例)进行治疗,疗程6周。以汉密尔顿抑郁量表(HAND-17)及临床变化总体评价量表(CGI)评定疗效,不良反应症状量表(TESS)观察药物的不良反应。结果:艾司西酞普兰治疗抑郁症的总有效率为85.7%,与氟西汀治疗效果相当,但不良反应轻。结论:艾司西酞普兰是一种安全有效的抗抑郁药物。     

艾司西酞普兰与氟西汀治疗老年抑郁症的临床疗效比较

目的比较艾司西酞普兰与氟西汀治疗老年抑郁症的临床疗效。方法选择2016年11月-2019年7月江苏省靖江市第二人民医院收治的老年抑郁症患者103例,采用随机数字表法分为观察组52例与对照组51例,观察组采用艾司西酞普兰治疗,对照组采用氟西汀治疗。比较2组患者的临床疗效,治疗前后汉密尔顿抑郁量表(HAMD)评分、汉密顿焦虑量表(HAMA)评分,不良反应。结果观察组患者总有效率为90.38%,高于对照组的70.59%(χ²=6.449,P=0.011);治疗后,2组患者HAMD评分和HAMA评分均低于治疗前,且观察组低于对照组(P<0.01);观察组患者不良反应总发生率为15.38%,对照组患者不良反应总发生率为17.65%,2组比较无显著性差异(χ²=0.096,P=0.757)。结论艾司西酞普兰与氟西汀均可治疗老年抑郁症,但艾司西酞普兰的治疗效果优于氟西汀,HAMD评分及HAMA评分下降幅度更明显,改善老年患者的抑郁症状效果更佳,且不良反应少。     

艾司西酞普兰与舍曲林治疗老年抑郁症的对照研究

目的观察艾司西酞普兰与舍曲林治疗老年抑郁症的临床疗效和安全性。方法将64例老年抑郁症患者随机分为艾司西酞普兰组和舍曲林组,每组各32例,治疗观察6周。于治疗前及治疗2、4、6周末采用汉密尔顿抑郁量表(HAMD,17项)评定临床疗效,不良反应量表(TESS)评定不良反应。结果艾司西酞普兰组和舍曲林组抑郁量表总分较治疗前均有显著下降,差异有统计学意义(P<0.01);但艾司西酞普兰组2周末汉密顿抑郁量表总分较舍曲林组下降更显著,差异有统计学意义(P<0.05)。治疗6周时两组临床疗效相似,舍曲林组出现恶心、出汗、心动过速比例明显高于艾司西酞普兰组,差异有统计学意义(P<0.05)。结论艾司西酞普兰和舍曲林治疗老年抑郁症的疗效相当,艾司西酞普兰起效更快,不良反应轻微。     

Cost–utility comparison of escitalopram and sertraline in the treatment of major depressive disorder

ABSTRACT

Objective: To construct a cost–utility model comparing escitalopram with sertraline in the treatment of major depressive disorders.

Methods: A decision analytic model was created to compare the cost–utility of these two antidepressants from the perspective of a managed-care organization. The model was designed to compare 10–20?mg/day of escitalopram to 50–200?mg/day of sertraline. Benefits (utility) scores were calculated based on clinical and utility data obtained from the literature. Direct medical costs included costs of the antidepressants, titration, treatment failures, and adverse events. Costs and benefits were modeled for a 6-month period and the model was subjected to thorough sensitivity analyses.

Results: The estimated 6-month total cost was $919 for escitalopram and $1351 for sertraline. The estimated QALYs were 0.40296 for escitalopram and 0.39268 for sertraline. These differences were mostly due to differences in drug acquisition costs and adverse events. The robustness of the cost–utility model results were tested in a Monte Carlo simulation of 10?000 patients and it indicated an 88.5% probability that escitalopram was the dominant therapy, suggesting both lower costs and greater QALYs.

Conclusion: This cost–utility model that incorporated the costs of titration and impact of side-effects comparing escitalopram 10–20?mg per day and sertraline 50–200?mg per day shows that escitalopram appeared to be less costly and produced efficacy (utility) at least as good as and maybe slightly better than that of sertraline.     

艾司西酞普兰与氟西汀治疗广泛性焦虑的对照研究

目的:探讨艾司西酞普兰对广泛性焦虑病人的临床疗效和安全性.方法:随机分为艾司西酞普兰组和氟西汀组,艾司西酞普兰10～20 mg/d,氟西汀10～20 mg/d.疗效采用汉密尔顿焦虑量表(HAMA)评定,不良反应和安全性用TESS和实验室检查评定.观察时间为8周.结果:艾司西酞普兰组有效率76.7%,治愈率50%.氟西汀组有效率73.3%,治愈率43.3%,两组比较差异无显著性(P>0.05).结论:艾司西酞普兰治疗广泛性焦虑症病人安全有效,疗效和不良反应与氟西汀相似.     

R-citalopram counteracts the antidepressant-like effect of escitalopram in a rat chronic mild stress model

The selective serotonin (5-HT) reuptake inhibitor, citalopram, is a racemic mixture of the stereoisomers, S-(+)-citalopram (escitalopram) and R-(-)-citalopram (R-citalopram). R-citalopram has been shown to counteract the 5-HT enhancing properties of escitalopram in acute studies in animals. In the present study we report, for the first time, on an interaction between R-citalopram and escitalopram after repeated dosing in a rat chronic mild stress (CMS) model of depression. The effect of escitalopram (2.0, 3.9 and 7.8 mg/kg per day), R-citalopram (7.8 mg/kg per day) and escitalopram 3.9 mg/kg per day plus R-citalopram 7.8 mg/kg per day were studied and compared to the effect of citalopram (8.0 mg/kg per day), imipramine and R-fluoxetine (8.9 mg/kg per day). Significant effects relative to a vehicle-treated group were achieved from week 1 for escitalopram (3.9 and 7.8 mg/kg per day), from week 2 for citalopram (8.0 mg/kg per day), from week 3 for R-fluoxetine (8.9 mg/kg per day) and from week 4 for escitalopram (2.0 mg/kg per day) and imipramine (8.9 mg/kg per day). R-citalopram (7.8 mg/kg per day) and escitalopram (3.9 mg/kg per day) plus R-citalopram (7.8 mg/kg per day) did not differ significantly from vehicle. There were no drug-induced effects in non-stressed control groups. In conclusion, escitalopram showed a shorter time to response in the rat CMS model of depression than citalopram, which was faster acting than R-fluoxetine and imipramine. R-citalopram counteracted the effect of escitalopram. The mechanism of action of R-citalopram is, at the moment unclear, but may be relevant to the improved clinical antidepressant activity seen with escitalopram in comparison with citalopram, and may also indicate an earlier response to escitalopram compared to other selective serotonin reuptake inhibitors (SSRIs).     

The pharmacokinetics of standard antidepressants with aripiprazole as adjunctive therapy: studies in healthy subjects and in patients with major depressive disorder

Possible effects of the atypical antipsychotic aripiprazole on the pharmacokinetics of standard antidepressant therapies (ADTs) were assessed in two open-label, non-randomised studies in healthy subjects (Studies 1 and 2) and two placebo-controlled studies in patients with major depressive disorder (MDD) (Studies 3 and 4). Healthy subjects received venlafaxine 75 mg/day (Study 1; N = 38) or escitalopram 10 mg/ day (Study 2; N = 25) with the addition of aripiprazole 10-20 mg/day (10 mg/day fixed dose in Study 2) for 14 days. Patients with MDD (N = 498; Studies 3 and 4) received escitalopram (10-20 mg/day), fluoxetine (20-40 mg/day), paroxetine controlled-release (37.5-50 mg/day), sertraline (100-150 mg/day) or venlafaxine extended-release (150-225 mg/day) for 8 weeks plus placebo. Incomplete responders were randomised (1:1) to placebo or adjunctive aripiprazole 2-20 mg/day. Blood samples were collected for pharmacokinetic analysis of ADTs. Plasma concentration-time data from Studies 3 and 4 were combined for statistical analysis. In healthy subjects, point estimates [90% CI] for the ratios of geometric means of C( max) (venlafaxine 1.148 [1.083-1.217]; escitalopram 1.04 [0.99-1.09]) and AUC(TAU) (venlafaxine 1.183 [1.130-1.238]; escitalopram 1.07 [1.04-1.11]) indicated no meaningful increase in ADT exposure in the presence of aripiprazole. In patients, point estimates for mean plasma concentration ratios indicated no substantial effect of aripiprazole on any ADT escitalopram 0.970 [0.911-1.033], fluoxetine 1.177 [1.049-1.321], paroxetine 0.730 [0.598-0.892], sertraline 0.958 [0.887-1.035] or venlafaxine 0.966 [0.887-1.051]. Aripiprazole had no meaningful effects on the pharmacokinetics of standard ADTs in either healthy subjects or patients with MDD.     

Escitalopram in obsessive–compulsive disorder: a randomized,placebo-controlled,paroxetine-referenced,fixed-dose, 24-week study

ABSTRACT

Objective: A randomized, placebo-controlled fixed-dose trial was undertaken to determine the efficacy and tolerability of escitalopram in obsessive–compulsive disorder (OCD), using paroxetine as the active reference.

Research design and methods: A total of 466 adults with OCD from specialized clinical centres, psychiatric hospital departments, psychiatric practices, or general practice were randomized to one of four treatment groups: escitalopram 10?mg/day (n = 116), escitalopram 20?mg/day (n = 116), paroxetine 40?mg/day (n = 119), or placebo (n = 115) for 24 weeks. The primary efficacy endpoint was the mean change in the Yale–Brown Obsessive–Compulsive Scale (Y?BOCS) total score from baseline to week 12. Secondary efficacy endpoints included remission (defined as Y?BOCS total score ≤10), NIMH?OCS, and CGI?S and CGI?I scores at weeks 12 and 24. Tolerability was based on the incidence of adverse events, and on changes in vital signs (blood pressure and pulse).

Main outcome measures; Results: Escitalopram 20?mg/day was superior to placebo on the primary and all secondary outcome endpoints, including remission. Escitalopram 10?mg/day and paroxetine 40?mg/day were also effective on the primary scale as well as some other outcome measures. In the escitalopram 20?mg/day group, the improvement in Y?BOCS total score was significantly better than in the placebo group as early as week 6. The most common AEs in the active treatment groups were nausea (19–27%), headache (17–22%), and fatigue (12–19%). More paroxetine-treated patients withdrew due to adverse events than escitalopram- or placebo-treated patients.

Conclusion: Given that escitalopram 20?mg/day was associated with an earlier onset, higher response and remission rates, improved functioning, and better tolerability than the reference drug, escitalopram deserves to be considered as one of the first-line agents in the pharmacotherapy of OCD for longer-term treatment periods.     

Escitalopram (S‐Enantiomer of Citalopram): Clinical Efficacy and Onset of Action Predicted from a Rat Model

Abstract: Escitalopram is the active S‐enantiomer of citalopram. In a chronic mild stress model of depression in rats, treatments with both escitalopram and citalopram were effective; however, a faster time to onset of efficacy compared to vehicle treatment was observed for escitalopram‐treated (5 mg/kg/day) than for citalopram‐treated (10 mg/kg/day) rats at Week 1. To study the predictability of this observation in the clinic, we analysed 4‐week data from an 8‐week, double‐blind, randomised, placebo‐controlled, flexible‐dose study that compared escitalopram and citalopram to placebo in primary care patients with major depressive disorder (baseline Montgomery and Åsberg Depression Rating Scale (MADRS) scores ≥22 and ≤40). Since the flexible dosing started after Week 4, analysis of 4‐week data ensured that the patients received fixed doses of 10 mg/day escitalopram (155 patients), 20 mg/day citalopram (160 patients), or placebo (154 patients). The efficacy analysis showed a significantly superior therapeutic effect for escitalopram versus placebo from Week 1 onwards (observed cases) with an adjusted mean change in MADRS at Week 4 (last observation carried forward) of 2.7 points (P=0.002). By comparison, 20 mg/day citalopram did not demonstrate a statistically significant effect compared to placebo. Escitalopram was well tolerated with an adverse event profile similar to that of citalopram. The preclinical observation that escitalopram possesses a faster time to onset of efficacy than citalopram was also seen in primary care patients with major depressive disorder. Thus, escitalopram is efficacious in depression and the effect occurs earlier than for citalopram.     

An open randomized study of the treatment of escitalopram alone and combined with gamma-hydroxybutyric acid and naltrexone in alcoholic patients.

gamma-hydroxybutyric acid (GHB) and the selective serotonin reuptake inhibitor escitalopram are effective in inducing and maintaining abstinence in alcohol. Naltrexone (NTX), an opioid antagonist, may be effective in preventing relapse in alcohol-dependent subjects. To evaluate whether each drug and its combination help to maintain alcohol abstinence, we determined the relapse rate over 6 months in 3 groups of patients. Group 1 (11 patients) received escitalopram (20 mg/day) orally administered; group 2 (12 patients) received NTX (50 mg/day) and escitalopram (20 mg/day); group 3 (12 patients) received GHB (75 mg/kg body weight) and escitalopram (20 mg/day); and group 4 (12 patients) received NTX (50mg/day) plus GHB (75 mg/kg) and escitalopram (20 mg/day). All groups received psychological support and underwent urine tests for alcohol metabolites twice a week. In group 1 (escitalopram only), 6 patients relapsed within 3 months and 3 after 6 months; whereas 2 patients remained abstinent. In group 2 (SSRI+NTX), 5 patients relapsed after 3 months and 3 after 6 months; whereas 4 patients remained abstinent. In group 3 (GHB+SSRI), 3 patients relapsed after 3 months and 3 after 6 months; whereas 6 patients remained abstinent. Finally, in group 4 (NTX+GHB+SSRI), 1 patient relapsed after 3 months and 1 after 6 months, whereas 10 patients remain abstinent. In conclusion, the combination of NTX+GHB+SSRI was the most effective in preventing relapses.     

Escitalopram (10-20 mg/day) is effective and well tolerated in a placebo-controlled study in depression in primary care

Escitalopram was compared to placebo in moderately to severely depressed patients in primary care with citalopram as the active reference. Patients were randomized to receive flexible doses of 10-20 mg/day escitalopram (n=155), 20-40 mg/day citalopram (n=160), or placebo (n=154) over an 8-week double-blind period. The primary efficacy parameter was the change from baseline to last assessment in the Montgomery-Asberg Depression Rating Scale total score. Escitalopram produced a statistically significant therapeutic difference of 2.9 points (P=0.002) compared to placebo, and escitalopram was consistently and statistically significantly more efficacious than placebo from week 1 onwards. Analysis of Clinical Global Impression-Severity and Clinical Global Impression-Improvement confirmed the primary efficacy results. By week 8, significantly more patients had responded to treatment with escitalopram than with citalopram (P=0.021) or placebo (P=0.009). Escitalopram was as well tolerated as citalopram and had a similar adverse event profile. Both escitalopram- and citalopram-treated patients had placebo-level adverse event withdrawal rates (3% and 4%, respectively). This study demonstrates the consistent antidepressant efficacy and excellent tolerability of escitalopram 10-20 mg/day in primary care patients with major depressive disorder.     

Escitalopram and duloxetine in the treatment of major depressive disorder: a pooled analysis of two trials

Pooled analyses have shown that escitalopram has superior effectiveness versus all comparators, including selective serotonin reuptake inhibitors and venlafaxine. Recent studies have compared escitalopram with duloxetine. Data from two randomized, double-blind studies that compared escitalopram (10-20 mg/day) and duloxetine (60 mg/day) were pooled and analysed for all patients and for the subsample of severely depressed patients [baseline Montgomery-Asberg Depression Rating Scale (MADRS) score > or =30]. Escitalopram (n=280) was superior to duloxetine (n=284) with respect to mean change from baseline in MADRS score at weeks 1, 2, 4 and 8 with a mean treatment difference at week 8 of 2.6 points (P<0.01). Similar results were seen for severely depressed patients, with a mean treatment difference of 3.7 points (P<0.01). Response and remission rates at week 8 were significantly higher for patients treated with escitalopram [response 67.1% for escitalopram compared with 53.2% for duloxetine, P<0.001; remission (MADRS< or =12) 54.3% for escitalopram compared with 44.4% for duloxetine, P<0.05]. The numbers needed to treat based on response and remission rates, in favour of escitalopram, were 8 and 11, respectively, for all patients (6 and 7, respectively, for severely depressed patients). Significantly fewer (P<0.001) patients (all cause and owing to adverse events) withdrew from the escitalopram group. This pooled analysis shows that over an 8-week treatment period, escitalopram (10-20 mg/day) is superior in both effectiveness and tolerability compared with duloxetine (60 mg/day).