度洛西汀与文拉法辛治疗老年抑郁症的疗效及对血清脑源性神经生长因子、5-羟色胺、去甲肾上腺素的影响

目的探讨度洛西汀与文拉法辛治疗老年抑郁症的疗效及对血清脑源性神经生长因子(BDNF)、5-羟色胺(TH)、去甲肾上腺素(NE)的影响。方法选择107例老年抑郁症患者为研究对象,抽签随机分为观察组(55例)和对照组(52例)。对照组给予文拉法辛,观察组给予度洛西汀。治疗8 w,观察两组临床疗效及血清BDNF、5-TH、NE水平的变化。结果 (1)观察组总有效率96. 36%,对照组总有效率82. 69%,差异有统计学意义(P0. 05);(2)治疗后两组HAMD评分差异有统计学意义(P0. 05),且随着时间的延长逐渐下降(P0. 05);(3)治疗后两组血清BDNF、5-TH、NE水平差异有统计学意义(P0. 05),且随着时间的延长逐渐升高(P0. 05);(4)两组不良反应发生情况差异无统计学意义(P0. 05)。结论度洛西汀治疗老年抑郁症的临床疗效优于文拉法辛,可能与更好地调节BDNF、5-TH、NE水平有关。     

度洛西汀治疗抑郁症的疗效观察

目的探讨度洛西汀对抑郁症的疗效和安全性。方法 70例抑郁发作患者随机分为度洛西汀组和氟西汀组,每组35例,分别给予度洛西汀和氟西汀治疗,疗程6周。用汉密尔顿抑郁量表（HAMD）评定疗效,用不良反应量表（TESS）评定不良反应。结果治疗1～2周,度洛西汀组HAMD评分较氟西汀组显著下降（P〈0.05）,治疗4～6周,两组相仿（P〉0.05）。两组间不良反应差异无显著性（P〉0.05）。结论度洛西汀是一种起效较快,且安全、有效的新型抗抑郁药。     

经颅直流电刺激联合度洛西汀治疗老年抑郁症的效果

目的 探究经颅直流电刺激(tDCS)联合度洛西汀治疗老年抑郁症的临床效果。方法 选取100例老年抑郁症患者,随机分为治疗组和对照组,各50例。对照组使用药物度洛西汀进行治疗,治疗组tDCS联合度洛西丁治疗,两组治疗时间均为6 w。比较两组治疗6 w的临床效果;比较两组在治疗前、治疗6 w的抑郁自评量表(SDS)评分与生活质量评价量表(SF-36)评分;比较两组治疗前、治疗6 w的去甲肾上腺素(NE)、5-羟色胺(HT)、脑源性神经生长因子(BDNF)水平。结果 治疗6 w,治疗组总有效率显著高于对照组(P<0.05);治疗前,两组SDS评分、5-HT、NE、BDNF水平、SF-36评分比较无显著差异(P>0.05),治疗6 w,治疗组5-HT、NE、BDNF水平、SF-36评分均显著高于对照组,SDS评分显著低于对照组(P<0.05)。结论 tDCS联合度洛西汀治疗老年抑郁症的效果较好,可保护和修复患者大脑神经元,降低SDS评分,提高患者生活质量。     

度洛西汀治疗体位性低血压伴焦虑抑郁的疗效观察

目的观察度洛西汀对伴有焦虑抑郁的体位性低血压的疗效和安全性。方法筛选2013年3月—2015年3月河北医科大学第一医院门诊或病房收治的体位性低血压病人30例,其中合并焦虑抑郁情绪者16例,采用度洛西汀治疗(度洛西汀组),另14例采用盐酸米多君治疗(米多君组)。在用药前及用药2周、8周后,根据1周内头晕、晕厥发生的次数、立卧位血压的变化、皮肤交感反应(SSR)、汉密尔顿焦虑量表(HAMA)14、汉密尔顿抑郁量表(HAMD)24的变化评定药物疗效,用不良反应量表(TESS)评定用药的安全性。结果药物疗效评价:头晕、晕厥的每周发生次数:两组治疗后均较治疗前有明显下降(P0.001),在治疗第8周末,度洛西汀组1周内头晕、晕厥发生的次数明显低于米多君组[(2.05±1.98)次/周vs(6.28±2.15)次/周,t=5.609,P0.001]。立卧位血压:度洛西汀组和米多君组收缩压及舒张压与用药前相比均明显降低(P0.01)。皮肤交感反应变化:两组治疗后潜伏期较治疗前缩短(P0.05),波幅较治疗前升高(P0.05)。度洛西汀组治疗后HAMA14分值(F=297.57,P0.001)、HAMD24分值(F=180.16,P0.001)与治疗前相比均有明显下降。TESS评定:两组间的药物不良反应比较差异无统计学意义(P0.05)。结论度洛西汀不但能改善体位性低血压病人的焦虑抑郁情绪,而且通过提高立位血压,可有效缓解体位性低血压导致的眩晕及晕厥,改善自主神经功能。     

抗抑郁药治疗肠易激综合征的研究进展

目前研究发现精神心理因素在肠易激综合征（IBS）的发病中起重要作用,抗抑郁药在治疗IBS中的作用已受到越来越多的关注。常用的抗抑郁药包括选择性5-羟色胺再摄取抑制剂（SSRIs）、三环类抗抑郁药（TCAs）、5-羟色胺和去甲。肾上腺素再摄取抑制剂（SNRIs）等。本文就近年抗抑郁药治疗IBS的研究进展作一综述。     

度洛西汀治疗老年支气管哮喘患者伴发抑郁的疗效分析

目的探讨度洛西汀联合心理治疗老年支气管哮喘伴发抑郁患者的疗效和不良反应。方法 64例老年支气管哮喘患者伴发抑郁患者随机分成两组,合用组为度洛西汀联合心理治疗,单用组为度洛西汀,疗程为6周。采用汉密顿抑郁量表(HAMD-17)评定疗效,用症状量表(TESS)评定用药不良反应。结果治疗6周末,合用组有效率为87.5%,单用组有效率为68.75%,两组比较差异有显著性(χ2=4.27,P<0.05)。两组TESS评分比较差异无显著性(t=1.25,P>0.05)。结论度洛西汀联合心理治疗老年支气管哮喘伴发抑郁患者疗效好,安全性高,依从性好。     

逆转由5-羟色胺伴发的性快感缺失

问:性功能不足可伴发于采用环杂类抗抑郁药时,并能用氯化乌拉胆碱或溴化新斯的明等胆碱能制剂来治疗,5-羟色胺再摄取阻滞剂——盐酸氟苯氧丙胺(fluoxetine hydrochloride)亦会对男女病人性欲有损害。应采用何药来对抗此药所致的性功能不足呢?答:氟苯氧丙胺是一种强力5-羟色胺再摄取阻滞剂。对再摄取其它单胺类影响甚少。有报告本     

腹泻型肠易激综合征临床特征与结肠黏膜5-羟色胺3受体表达

在肠易激综合征(IBS)发病机制中,5-羟色胺(5-HT)和5-羟色胺受体(5-HTR)所起的作用不容忽视.研究表明,5-HT作为脑-肠轴中重要的神经递质,参与胃肠道运动、分泌功能和内脏感知的调节.     

5-羟色胺与阻塞性睡眠呼吸暂停低通气综合征的关系

我们采用放射免疫法检测阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者血浆中的5-羟色胺含量，探讨5-羟色胺与OSAHS发病的关系。     

正常人与冠心病、高血压病人血小板内外5-HT和血小板聚集性增龄性变化的研究

本文对50名正常人血小板及血浆5-羟色胺和血小板聚集性进行了增龄性变化观察并与冠心病和高血压病人的相应指标进行了比较。结果表明,血小板5-羟色胺随龄降低,血浆5-羟色胺和血小板聚集性随龄增高。冠心病及高血压病人血小板5-羟色胺明显降低,而血浆5-羟色胺和血小板聚集性明显增加并与病情轻重有关。     

Rapid onset of syndrome of inappropriate antidiuretic hormone secretion induced by duloxetine in an elderly type 2 diabetic patient with painful diabetic neuropathy

Diabetic neuropathy is the most common diabetic complication. Duloxetine, a serotonin noradrenaline reuptake inhibitor (SNRI), is widely used for the treatment of diabetic painful neuropathy (DPN) because of the efficacy and safety profile. Syndrome of inappropriate antidiuretic hormone secretion, which is strongly associated duloxetine, is a rare but occasionally life‐threatening adverse effect. Here, we report a case of syndrome of inappropriate antidiuretic hormone secretion that rapidly developed after starting duloxetine in an elderly Japanese female type 2 diabetes mellitus patient. Furthermore, we discuss the possible relationship between the onset of syndrome of inappropriate antidiuretic hormone secretion and the gene polymorphism of cytochrome P450 isoform 1A2 and 2D6, both of which are responsible for duloxetine metabolism.     

Fibromyalgiesyndrom

Fibromyalgia syndrome (FMS) affects 2-10% of the adult population in industrial countries and although it is associated with substantial morbidity and disability, treatment options are unsatisfactory. The rapid growth of trials for FMS in recent years has resulted in new, evidence-based approaches to medical treatment. This review focuses on the randomized, controlled studies of newer pharmacological options for FMS, such as selective serotonin/norepinephrine reuptake inhibitors (duloxetine, milnacipran), inhibitors of voltage-gated calcium channels (pregabalin, gabapentin), dopamine-2/3-receptor agonists (pramipexole, ropirinole), sedative-hypnotic agents (sodium oxybate, modafinil, dronabinol), 5-HT3 antagonists (tropisetron) and others (tramadol, dextromethorphan, olanzapine).     

A systematic review on the effectiveness of treatment with antidepressants in fibromyalgia syndrome

OBJECTIVE: To systematically review the efficacy of treatment of fibromyalgia syndrome (FMS) with antidepressants. METHODS: We screened Medline, PsychINFO, SCOPUS, and the Cochrane Library databases (through October 2007) and the reference sections of original studies, meta-analyses, and evidence-based guidelines and recommendations on antidepressants in FMS. Randomized controlled trials (RCTs) on the treatment of FMS with antidepressants were analyzed. Inclusion criteria, study characteristics, quality, and all outcome measures were investigated. RESULTS: Twenty-six of 167 studies were included. The main outcome variables reviewed were pain, fatigue, sleep, depressiveness, and quality of life. Amitriptyline, studied in 13 RCTs, was efficient in reducing pain with a moderate magnitude of benefit (pain reduction by a mean of 26%, improvement in quality of life by 30%). Selective serotonin reuptake inhibitors (SSRIs) were studied in 12 RCTs, which also showed positive results, except for 2 studies on citalopram and 1 on paroxetine. Three RCTs on the dual serotonin and noradrenaline reuptake inhibitors (SNRIs) duloxetine and milnacipran and 1 of the 2 RCTs using the monoamine oxidase inhibitor moclobemide reported a positive result. The longest study duration was 12 weeks. CONCLUSION: Amitriptyline 25-50 mg/day reduces pain, fatigue, and depressiveness in patients with FMS and improves sleep and quality of life. Most SSRIs and the SNRIs duloxetine and milnacipran are probably also effective. Short-term treatment of patients with FMS using amitriptyline or another of the antidepressants that were effective in RCTs can be recommended. Data on long-term efficacy are lacking.     

Duloxetine-induced Syndrome of Inappropriate Secretion of Antidiuretic Hormone in a Super-elderly Patient

Duloxetine is widely used for pain control and depressive syndromes. One of its potential side effects is syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Duloxetine-induced SIADH causes hyponatremia, which leads to a variety of symptoms and has previously been reported in the elderly. In the present case, we experienced a case of the rapid onset of SIADH in a super-elderly woman receiving low-dose duloxetine. Elderly patients tend to have lower duloxetine doses and an earlier onset than non-elderly patients. When hyponatremia occurs after duloxetine administration, duloxetine-induced SIADH should be considered, especially in high-risk elderly patients, regardless of the duloxetine dose or duration of treatment.     

Takotsubo cardiomyopathy associated with titration of duloxetine

Takotsubo cardiomyopathy is characterized by transient multisegmental left ventricular dysfunction, dynamic electrocardiographic changes that mimic acute myocardial infarction, and the absence of obstructive coronary disease. Takotsubo cardiomyopathy has been solidly associated with antecedent emotional and physical stressors that trigger catecholamine surges, which lead to coronary vasospasm or direct myocardial injury. Some medications can also cause catecholamine surges, although this phenomenon is not as well described. Duloxetine is a combined serotonin and norepinephrine reuptake inhibitor (SNRI). The basic goal of SNRIs is to increase catecholamine levels in neuronal tissue. However, the increased catecholamine levels may also affect the cardiovascular system.Herein, we report the case of a 59-year-old woman whose takotsubo cardiomyopathy was temporally associated with the titration of duloxetine. The duloxetine therapy was subsequently discontinued, and the patient's left ventricular function recovered completely 1 month after the index event. The purpose of this report is to alert clinicians to a possible association between SNRI medications and takotsubo cardiomyopathy.     

Superiority of duloxetine to placebo in improving diabetic neuropathic pain: Results of a randomized controlled trial in Japan

Aims/Introduction:  Duloxetine has been suggested to exert analgesic effects by activating the descending inhibitory system through inhibition of serotonin (5‐HT) and noradrenaline (NA) reuptake. This randomized controlled trial investigated the efficacy and safety of duloxetine in Japanese patients with diabetic neuropathic pain (DNP).Materials and Methods:  Duloxetine 40 or 60 mg/day or placebo was given orally once daily for 12 weeks. The primary efficacy measure was weekly mean 24‐h average pain severity score on the 11‐point Numerical Rating Scale.Results:  At 12 weeks vs baseline, the 24‐h average pain score (adjusted mean ± SE) was significantly improved in the combined duloxetine (−2.47 ± 0.18) and duloxetine 40 mg (−2.41 ± 0.21) and 60 mg groups (−2.53 ± 0.21) as compared with the placebo group (−1.61 ± 0.18). Duloxetine also exerted significant improvements over the placebo in nearly all secondary outcome measures including 24‐h worst pain, night pain, Brief Pain Inventory (BPI) pain scores, Patient’s Global Impression of Improvement (PGI‐I) and health outcome measures, namely, various BPI interference scores. The incidence of adverse events (AE) was higher in the duloxetine groups than in the placebo group (duloxetine overall, 84.8%; duloxetine 40 mg, 84.7%; duloxetine 60 mg, 84.9%; placebo, 73.7%). Most AE were mild or moderate in severity, and resolved or relieved. There were no clinically significant safety concerns.Conclusions:  Duloxetine 40 or 60 mg/day showed superiority over the placebo at reducing pain scores in patients with DNP. Duloxetine is safe, efficacious and clinically useful in the management of DNP. This trial was registered with ClinicalTrials.gov (no. NCT‐00552175). (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2010.00073.x, 2010)     

Serotonin syndrome after concomitant treatment with linezolid and meperidine.

Serotonin syndrome has been reported with administration of linezolid and serotonin reuptake inhibitors. Meperidine blocks the neuronal reuptake of serotonin. Serotonin syndrome after concomitant linezolid and meperidine therapy has not been described. We describe serotonin syndrome after concomitant use of linezolid and meperidine in a 27-year-old man with acute leukemia.     

Serotonin syndrome as a result of escitalopram and cyclosporin combination in an 84-year-old woman

Due to the stimulation of central and peripheral 5-hydroxytryptamine receptors, the serotonin syndrome is a potentially lethal situation. The large variety of its clinical manifestations leads to a difficult diagnosis. We describe the case of a serotonin syndrome induced by the combined escitalopram and cyclosporine administration. An 84-year-old woman was hospitalized with a history of delirium associated with hyperthermia. The diagnosis of serotonin syndrome was suspected with the combination of the clinical features: the absence of infection, the selective serotonin reuptake inhibitor administration, and the absence of other metabolic and cerebral aetiology. After the discontinuation of escitalopram, the patient's condition improved rapidly. This report is a reminder of the clinical and pharmacological features of the serotonin syndrome from a recent literature review.     

Tramadol: Understanding the Risk of Serotonin Syndrome and Seizures

Tramadol is commonly prescribed for pain control because it presents a lower risk for addiction and respiratory depression compared to other opioids. However, tramadol's serotonin and norepinephrine reuptake inhibitory effects result in a unique adverse effect profile. Two such adverse events are serotonin syndrome and seizures. The prevalence of tramadol-induced serotonin syndrome and seizures is modest in the general population, but if left untreated, the morbidity and mortality can be high; therefore, prompt recognition and management is essential. Various risk factors such as medical comorbidities, use or abuse of supratherapeutic doses of tramadol, and concomitant administration of proconvulsant serotonergic cytochrome P-450 inhibitors will help clinicians identify individuals at an elevated risk for serotonin toxicity and seizures. Serotonin syndrome and seizures can be effectively treated by administering benzodiazepines, providing supportive care, and discontinuing tramadol and other contributing agents. Cyproheptadine should be administered in moderate to severe cases of serotonin syndrome. Our objective is to summarize the literature on the pharmacology, epidemiology, risk factors, clinical presentations, and evidence-based management of tramadol-related seizures and serotonin syndrome.     

The Serotonin Transporter Polymorphism rs25531 Is Associated with Irritable Bowel Syndrome

Irritable bowel syndrome is a frequent gastrointestinal disorder of unknown etiology. The serotonin transporter regulates the intensity and duration of serotonin signaling in the gut and is, therefore, an attractive candidate gene for irritable bowel syndrome. Previous studies investigating the 5-HTTLPR and Stin2 VNTR polymorphisms of the serotonin transporter have proved inconclusive. In this exploratory study we therefore expanded the search for a possible association of the serotonin transporter with irritable bowel syndrome to include not only the 5-HTTLPR and Stin2 VNTR length polymorphisms, but also the functional single nucleotide polymorphism rs25531. We genotyped 186 patients with irritable bowel syndrome and 50 healthy control subjects raging in age from 18 to 70 years. Carriers of the rare G allele of rs25531 had approximately threefold increased odds of irritable bowel syndrome compared with healthy controls (OR 3.3, 95% CI 1.1–9.6). Our findings suggest that further investigation of the possible role of the serotonin transporter in the etiology of IBS is warranted.