九味镇心颗粒治疗广泛性焦虑障碍疗效观察

目的：探讨九味镇心颗粒治疗广泛性焦虑障碍的疗效与安全性。方法：112例广泛性焦虑障碍患者随机分为研究组和对照组,每组56例,分别给予九味镇心颗粒和帕罗西汀治疗,疗程6周。采用汉密尔顿焦虑量表（HAMA）观察两组疗效,采用副反应量表（TESS）观察两组药品不良反应。结果：两组治疗后2周HAMA评分均较前明显下降（P〈0.01）,治疗前、后各时间点两组间HAMA评分比较,差异无统计学意义（P〉0.05）。两组治愈率、有效率比较,差异均无统计学意义（P〉0.05）。研究组不良反应发生率为14.8%,低于对照组的22.6%（P〈0.05）,两组TESS总分比较,差异无统计学意义（P〉0.05）。结论：九味镇心颗粒治疗广泛性焦虑障碍疗效与帕罗西汀相仿,但不良反应较少,安全性好。     

度洛西汀治疗抑郁伴焦虑障碍患者的随机双盲对照研究

目的比较度洛西汀与帕罗西汀治疗抑郁伴焦虑障碍的疗效和安全性。方法对24例符合CCMD-3抑郁发作和广泛性焦虑诊断标准的患者随机双盲进入度洛西汀或帕罗西汀组治疗6周,分别在治疗前及第1、2、4、6周末进行汉密尔顿抑郁量表17项（HAMD）、汉密尔顿焦虑量表（HAMA）和临床疗效总评量表的病情严重程度（CGI-SI）评定,进行体格检查、实验室检查,及采用副反应量表（TESS）评估用药安全性。结果经6周治疗后显示,度洛西汀总体疗效比帕罗西汀稍好且起效快,效果良好,在治疗第1周末HAMD总分与帕罗西汀组有显著性差异（P〈0.05）。两组不良反应均较轻微。结论度洛西汀抗抑郁及抗焦虑作用确切,可用于治疗抑郁症伴焦虑障碍。     

文拉法辛缓释剂治疗广泛性焦虑障碍的疗效观察

目的探讨文拉法辛缓释剂治疗不伴有抑郁的广泛性焦虑障碍的临床疗效及安全性。方法共88例不伴有抑郁的广泛性焦虑障碍患者入组，文拉法辛缓释剂治疗46例，观察组42例，使用HAMA判断疗效，并记录不良反应。结果77例完成试验（文拉法辛缓释剂41例，观察组36例），结果显示文拉法辛缓释剂治疗GAD有效率为69％，显著优于观察组36％（P〈0．01）；文拉法辛缓释剂治疗后各随访点HAMA评分与观察组比较差异均有显著性（P〈0．05）。结论文拉法辛缓释剂治疗GAD疗效肯定，显著优于观察组，耐受性好，不良反应少，适合临床应用。     

文拉法新缓释片治疗广泛性焦虑的疗效

目的探讨文拉法新缓释片治疗广泛性焦虑患者的疗效及副反应。方法将168例广泛性焦虑症患者随机分为文拉法新缓释片组（研究组）和西酞普兰组（对照组）,疗程6周,并用汉密顿焦虑量表（HAMA）、临床疗效总评量表（CGI-SI）、药物副反应评定量表（TESS）对患者治疗前后进行评定。结果在治疗的第2、4、6周末两组的HAMA分值差异有统计学意义（P〈0.05）。在治疗6周末时,研究组显效率为78.6%,有效率为90.4%,对照组分别为73.8%,85.7%,两组差异有统计学意义（P〈0.05）。在副反应方面,两组差异无统计学意义（P〈0.05）。结论文拉法新缓释片治疗广泛性焦虑安全有效。     

帕罗西汀联合九味镇心颗粒治疗广泛性焦虑障碍疗效观察

摘 要 目的:探讨帕罗西汀联合九味镇心颗粒治疗广泛性焦虑障碍的疗效与安全性。方法：150例广泛性焦虑障碍患者随机分为研究组和对照组各75例。研究组给予帕罗西汀片联合九味镇心颗粒治疗,对照组单用帕罗西汀片治疗,疗程均为6周。比较两组汉密尔顿焦虑量表（HAMA）评分变化和临床疗效、药品不良反应。结果：研究组脱落2例,共73例完成观察,对照组脱落6例,共67例完成观察。研究组治疗1周末起HAMA评分较前明显下降（P＜0.01）,对照组治疗2周末起HAMA评分较前明显下降（P＜0.01）;两组治疗前后各时段HAMA评分比较,差异无统计学意义（P>0.05）。治疗后,两组治愈率、有效率比较,差异均无统计学意义（P>0.05）。两组药品不良反应发生率比较,差异无统计学意义(P>0.05)。结论：帕罗西汀联合九味镇心颗粒治疗广泛性焦虑障碍,起效快、安全性好,值得临床推广。     

文拉法辛缓释剂与阿普唑仑治疗广泛性焦虑症的对照研究

目的：比较文拉法辛缓释剂和阿普唑仑治疗广泛性焦虑障碍的疗效。方法选取2013年2—7月在广元市精神卫生中心就诊的符合CCMD-3中广泛性焦虑障碍诊断标准的患者67例,随机分为研究组34例和对照组33例。研究组口服文拉法辛缓释剂治疗,对照组口服阿普唑仑治疗,疗程为4周。临床疗效判定依据汉密尔顿焦虑量表（ HAMA）减分率,不良反应采用不良反应量表（ TESS）评定。结果两组有效率比较,差异无统计学意义（ P﹥0.05）。治疗前两组HAMA评分比较,差异无统计学意义（ P﹥0.05）。第2周时研究组HAMA评分、精神性焦虑评分、躯体性焦虑评分低于对照组,差异有统计学意义（ P﹤0.05）。在第4周时研究组HAMA评分、精神性焦虑评分低于对照组,差异有统计学意义（ P﹤0.05）。结论文拉法辛缓释剂治疗广泛性焦虑症的短期效果优于阿普唑仑,不良反应两者无差异。     

米氮平和帕罗西汀治疗广泛性焦虑的疗效比较

目的 比较米氮平和帕罗西汀治疗广泛性焦虑的疗效.方法 对63例符合条件的广泛性焦虑患者随机分组,分别选择米氮平和帕罗西汀治疗,分别采用HAMA和TESS评定疗效和副作用.结果 米氮平组治疗有效率为84.4%,帕罗西汀组治疗有效率为83.9%,两组之间疗效差异无统计学意义（P ＞ 0.05）;两组副反应均轻,主要表现为恶心、呕吐、头昏、口干等症状.结论 米氮平和帕罗西汀治疗广泛性焦虑均有良好的效果,且副反应轻,值得在临床推广.     

度洛西汀与帕罗西汀治疗社交焦虑症对照研究

目的比较度洛西汀与帕罗西汀治疗社交焦虑障碍的疗效及不良反应。方法对86例社交焦虑障碍门诊及住院患者,随机分为两组,度洛西汀组和帕罗西汀组各43例,治疗8周,采用汉密尔顿焦虑量表(HAMA)和临床疗效总评量表,病情严重程度量表(CGI-SI)评定临床疗效,用治疗中出现的症状量表(TESS)评定药物不良反应。结果经过8周治疗,度洛西汀组和帕罗西汀组有效率分别为86.05和83.72两组疗效差异无统计学意义(P>0.05),两组不良反应发生率差异无统计学意义(P>0.05)。结论度洛西汀和帕罗西汀对社交焦虑障碍的疗效相当,不良反应较小,值得临床推广。     

帕罗西汀与氟哌噻吨美利曲辛治疗躯体形式障碍对照研究

目的:探讨帕罗西汀与氟哌噻吨美利曲辛治疗躯体形式障碍的疗效及安全性。方法:将56例躯体形式障碍患者随机分为两组,A组以帕罗西汀治疗,B组以氟哌噻吨美利曲辛治疗,疗程均为8周。治疗前与治疗第1,2,4,8周采用症状自评量表(SCL-90)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评定临床疗效,不良反应量表(TESS)评定不良反应。结果:两组治疗2,4,8周末SCL-90、HAMD、HAMA评分均较治疗前减少(P<0.05或P<0.01);氟哌噻吨美利曲辛较帕罗西汀能更快改善患者的抑郁和焦虑症状(P<0.05)。治疗第8周末A组有效率为82.6%,B组有效率为73.0%(P<0.05)。两组不良反应发生率差异无统计学意义,大多出现在治疗早期,经对症治疗逐渐缓解。结论:帕罗西汀与氟哌噻吨美利曲辛治疗躯体形式障碍均有较显著的疗效,且安全性较高,临床可根据患者自身情况适当选用。     

帕罗西汀合并丙戊酸钠治疗伴有焦虑的抑郁症对照研究

目的探讨帕罗西汀合并丙戊酸钠治疗伴有焦虑的抑郁症患者的疗效及安全性。方法对符合入组标准的80例患者随机分为两组,实验组采用帕罗西汀合并丙戊酸钠治疗,对照组单独采用帕罗西汀治疗。结果两组治疗后各时点的HAMD、HAMA评分均较治疗前明显减少。治疗后实验组HA-MA分数明显低于对照组（P〈0.05）。治疗后实验组无转躁病例,对照组有3例转躁患者。结论对于伴有焦虑的抑郁症患者,帕罗西汀与丙戊酸钠缓释剂合用,对焦虑的疗效优于单用帕罗西汀,但对抑郁的疗效与单用帕罗西汀时差异不显著。另外,两药合用时,有可能预防双相情感障碍抑郁相转躁。     

Discontinuation symptoms in depression and anxiety disorders

The present overview investigates whether different antidepressants have differing discontinuation symptoms upon treatment cessation, if these symptoms vary between depression and anxiety disorders, and with length of treatment. Data came from two comparative studies of escitalopram in major depressive disorder (MDD) (one vs. venlafaxine XR and one vs. paroxetine), two studies in social anxiety disorder (SAD) (one of which used paroxetine as the active reference), and one study in generalized anxiety disorder (GAD), using paroxetine as an active reference [total number of patients: escitalopram (n=1051); paroxetine (n=336); venlafaxine XR (n=124); placebo (n=239)]. All studies included a defined discontinuation period and used the Discontinuation Emergent Signs and Symptoms (DESS) checklist to record the number of discontinuation symptoms. All three antidepressants showed more discontinuation symptoms compared with placebo (p<0.001). Patients reported significantly fewer discontinuation symptoms with escitalopram than with paroxetine and venlafaxine XR in MDD (p<0.05). Escitalopram showed significantly fewer discontinuation symptoms than paroxetine in SAD (p<0.05) and GAD (p<0.001). For each antidepressant, no differences in discontinuation symptoms were observed between the three indications and there was no evidence for increased symptom incidence with increased length of treatment. Thus, discontinuation profiles differ between antidepressants of the same class and are broadly similar in different disorders. No evidence was seen for a higher discontinuation burden with longer treatment.     

Effectiveness of venlafaxine,extended release formulation,in the short-term and long-term treatment of generalized anxiety disorder: results of a survival analysis

A survival analysis of data from two placebo-controlled, randomized, long-term (6-month) studies was used to examine the effectiveness of venlafaxine, extended release (XR) formulation, in patients with generalized anxiety disorder (GAD). Patients in a placebo-controlled, flexible-dose study received 75 to 225 mg/day venlafaxine XR, while patients in a placebo-controlled, fixed-dose study received once-daily venlafaxine XR doses of 37.5 mg, 75 mg, or 150 mg. The survival analysis was based on the clinician's decision to discontinue treatment in a placebo-controlled study and incorporated data from all patients who were randomized. In each study, placebo-treated patients discontinued treatment due to lack of efficacy more frequently and earlier than those receiving venlafaxine XR (p < 0.001, log-rank test). A dose-response relationship was apparent, with the lowest rate of withdrawal seen at the highest venlafaxine XR dose. Survival curves for discontinuations due to adverse events did not differ significantly in either study. These results were consistent with the conventional intent-to-treat efficacy assessments of changes in anxiety severity, highlighting the superiority of venlafaxine XR over placebo in the long-term treatment of GAD. Overall, these results demonstrate the clinical effectiveness of venlafaxine XR in the short-term and long-term treatment of GAD.     

Venlafaxine XR demonstrates higher rates of sustained remission compared to fluoxetine, paroxetine or placebo

The combined serotonin-norepinephrine reuptake inhibitor, venlafaxine XR, has demonstrated significant response and remission in patients diagnosed with depression when measured with the Hamilton Depression Rating Scale (HAM-D). This pooled analysis of data from five studies compared the sustained remission of depressive symptoms in patients treated with venlafaxine XR, the selective serotonin reuptake inhibitors (SSRIs) fluoxetine or paroxetine, or placebo. Data from 1391 subjects enrolled in five active and placebo-controlled studies who met the DSM-III-R or DSM-IV criteria for major depressive disorder were analysed. Three treatment groups were compared: venlafaxine XR (n = 560), fluoxetine/paroxetine (n = 298) and placebo (n = 496). Mean treatment duration was 8 weeks. Responders were defined as those patients whose HAM-D-21 score decreased by > or = 50% from baseline. Remission was defined as a HAM-D-17 score < or = 7. Sustained remission was defined as maintenance of remission through week 8 or the end of treatment (if before week 8) and for > or = 2 weeks. Between-group rate comparisons in outcome measures were carried out using Fisher's exact and log-rank tests. Venlafaxine XR produced significantly higher rates of sustained remission in depressed patients compared to fluoxetine/paroxetine or placebo over this 8-week treatment period. As early as week 2, a significantly greater proportion of patients treated with venlafaxine achieved improved depression scores (remission and response). A significantly greater rate of remission and sustained remission occurred with venlafaxine compared to placebo. Remission was achieved earlier with venlafaxine and lasted throughout the remainder of the study. These results demonstrate that venlafaxine XR is more effective than fluoxetine/paroxetine for sustaining remission of depressive symptoms.     

文拉法辛与帕罗西汀治疗抑郁症的对照研究

目的评价文拉法辛与帕罗西汀抑郁症的疗效及安全性。方法将72例抑郁症患者随机分为两组,分别给予文拉法辛和帕罗西汀治疗,疗程8周。用汉密尔顿抑郁量表（HAMD）评定临床疗效,副反应量表（TESS）评定不良反应。结果文法拉辛显效率为75％,有效率为91．7％,帕罗西汀组为72％,89．9％,两组疗效相仿。在治疗2周末时,文法拉辛组减分多于帕罗西汀,差异有显著性。两组不良反应均轻微。结论文拉法辛和帕罗西汀抑郁疗效肯定,不良反应轻。     

艾司西酞普兰与文拉法辛缓释剂治疗广泛性焦虑障碍的对照研究

目的:观察艾司西酞普兰与文拉法辛缓释剂治疗广泛性焦虑障碍的疗效和安全性。方法:将74例符合《国际疾病与相关健康问题统计分类(ICD)第10版》(ICD-10)广泛性焦虑障碍的患者随机分成艾司西酞普兰组(n=38)和文拉法辛缓释剂组(n=36),治疗持续8周,用汉密尔顿焦虑量表(HAMA)评定患者焦虑症状及疗效,用汉密尔顿抑郁量表(HAMD)评定患者的抑郁症状,同时用不良反应量表(TESS)和实验室检查评估治疗安全性。结果:治疗1周末两组HAMA评分开始明显下降(P<0.01),第1、2、4周末艾司西酞普兰组HAMA减分率明显高于文拉法辛缓释剂组(P<0.05),但是第8周末两组的减分率无统计学差异(P>0.05)。8周末两组的治愈率分别为60.5%和66.7%,有效率分别为78.9%和86.1%,文拉法辛缓释剂组显著高于艾司西酞普兰组(P<0.01)。8周末两组HAMD评分较治疗前也均有明显下降(P<0.01)。两组不良反应差异无统计学意义(P>0.05)。结论:文拉法辛缓释剂治疗广泛性焦虑总体疗效优于艾司西酞普兰,但是艾司西酞普兰起效快于文拉法辛缓释剂,两者安全性无明显差异。     

A non-inferiority comparison of duloxetine and venlafaxine in the treatment of adult patients with generalized anxiety disorder

The present study is a non-inferiority comparison of duloxetine 60-120 mg/day and venlafaxine extended-release (XR) 75-225 mg/day for the treatment of adults with generalized anxiety disorder (GAD). The non-inferiority test was a prespecified plan to pool data from two nearly identical 10-week, multicentre, randomized, placebo-controlled, double-blind studies of duloxetine 60-120 mg/day and venlafaxine 75-225 mg/ day for the treatment of GAD. An independent expert consensus panel provided six statistical and clinical criteria for determining non-inferiority between treatments. Response was defined as > or =50% reduction in Hamilton Anxiety Rating Scale (HAMA) total score. In the pooled sample, patients were randomly assigned to duloxetine (n = 320), venlafaxine XR (n = 333) or placebo (n = 331). For the non-inferiority analysis, the per-protocol patients who were treated with duloxetine (n = 239) or venlafaxine XR (n = 262) improved significantly more (mean HAMA reductions were -15.4 and -15.2, respectively) than placebo-treated patients (n = 267; -11.6, P < or = 0.001, both comparisons). Response rates were 56%, 58% and 40%, respectively. Discontinuation rate because of AEs was significantly higher for duloxetine (13.4%, P < or = 0.001) and venlafaxine XR (11.4%, P < or = 0.01) groups compared with placebo (5.4%). Duloxetine 60-120 mg/day met all statistical and clinical criteria for non-inferiority and exhibited a similar tolerability profile compared with venlafaxine XR 75-225 mg/day for the treatment of adults with GAD.     

Predictors of outcome following venlafaxine extended-release treatment of DSM-IV generalized anxiety disorder: a pooled analysis of short- and long-term studies

This pooled analysis evaluated potential predictive abilities of baseline demographic factors, psychiatric history, and DSM-IV diagnostic criteria for short- and long-term outcome after treatment with venlafaxine extended release (XR) or placebo in patients with generalized anxiety disorder (GAD). Pooled data from 1,839 patients in five placebo-controlled studies of venlafaxine XR for GAD were analyzed by logistic regression. Odds ratios (ORs) were used to quantify pretreatment factors' abilities to predict response (50% reduction, baseline Hamilton Rating Scale for Anxiety [HAM-A] severity) and remission (total HAM-A score 相似文献   

文拉法辛与帕罗西汀治疗抑郁症的临床疗效比较

目的：探讨文拉法辛与帕罗西汀在抑郁症治疗中的疗效。方法：对2010年1月—2012年1月收治的60例抑郁症患者以随机抽样法分为2组,分别为文拉法辛组30例与帕罗西汀组30例,在治疗2个月后,采用副反应量表（TESS）与汉斯尔顿抑郁量表（HAMD）检测患者在接受治疗后HAMD的降低数值,并对2组患者的疗效、不良反应进行观察。结果：经过两个月的治疗,文拉法辛组的HAMD评分与总有效率分别为（6.00±4.13）分、90%（27/30）,帕罗西汀组HAMD评分与总有效率分别为（5.76±3.54）分、96.7%（29/30）,2组比较,差异无统计学意义（P〉0.05）。2组患者的TESS评分结果表明,2种药物所引起的不良反应较为轻微,2组患者发生不良反应的情况比较,差异无统计学意义（P〉0.05）。结论：文拉法辛与帕罗西汀对抑郁症患者均具有疗效佳、耐受性好、安全性高的优点,在抑郁症的治疗中,不论是采取文拉法辛还是帕罗西汀,均可取得良好的临床疗效。     

Long-term treatment strategies in anxiety disorders

Anxiety disorders are prevalent and associated with increased morbidity and mortality. Some chronic anxiety disorders, including generalized anxiety disorder (GAD), may be characterized by an underlying high level of anxiety on which exacerbations of symptoms are superimposed. Effective treatment of anxiety disorders should therefore strive to attain both an acute reduction in the symptoms of anxiety (a response) and sustained resolution of the symptoms of any underlying chronic anxiety (remission). This strategy may necessitate long-term treatment of these disorders by pharmacotherapy and/or psychotherapy. Studies using the serotonin and norepinephrine reuptake inhibitor (SNRI), venlafaxine extended release (XR), suggest that these aims may be achieved using this newer class of drugs. Studies with venlafaxine XR in patients with GAD have demonstrated robust anxiolytic efficacy over placebo, particularly regarding worry, cognitive dysfunction, and muscular tension, which are specific to GAD. Administration of venlafaxine XR over both short- (8-week) and long-term (6-month) periods resulted in a significantly greater number of patients achieving response and remission than obtained with placebo. Long-term treatment with venlafaxine XR in patients with GAD showed greater efficacy than that observed in short-term studies. This was achieved without any loss of short-term efficacy and patients' social functioning was also restored. While available data indicate that venlafaxine XR is an appropriate choice of agent in the long-term treatment of GAD, more studies are needed to determine how to further increase remission rates and to maintain remission beyond 6 months.     

Remission rates with venlafaxine extended release in Greek outpatients with generalized anxiety disorder. A double-blind, randomized, placebo controlled study

The primary endpoints in this study were the remission rates [final Hamilton Rating Scale for Anxiety (HAM-A) total score < or =7] and reduction from baseline in the HAM-A total score in patients with generalized anxiety disorder (GAD) and no associated depression. Patients with GAD (DSM-IV and HAM-A total score >18) were randomly assigned to treatment with venlafaxine XR or placebo for 8 weeks. A 1-week placebo run-in period preceded the double-blind phase. Patients with a >20% drop in their total HAM-A score during the run-in period, were excluded from the double-blind phase. All patients started therapy with 75 mg/day venlafaxine XR or matched placebo. Patients with less than 30% decrease in their HAM-A total score at the end of the second week, doubled their dose. Patients on the 150 mg/day dose underwent a 1-week taper period. Of the 24 patients in the venlafaxine XR group, 62.5% achieved remission versus 9.1% in the placebo group (P=0.0006). The mean decrease from baseline in HAM-A total score was 19.2 points for the venlafaxine XR group and 10.8 points for the placebo group (P<0.001). Eleven placebo-treated patients and seven venlafaxine XR treated patients doubled their dose at the end of the second week of double-blind treatment. No patient interrupted therapy because of side-effects. No changes in systolic or diastolic blood pressure were observed. Venlafaxine XR 75-150 mg/day was well tolerated. The remission rates achieved with venlafaxine 75-150 mg/day in non-depressed GAD patients were high with good tolerability.