No difference in symptoms of irritable bowel syndrome between healthy subjects and patients with recurrent depression in remission

There is bidirectional comorbidity between anxiety/depression and irritable bowel syndrome (IBS). To investigate the prevalence of IBS symptoms, and factors associated with gastrointestinal symptoms in patients with recurrent depressive disorder. Patients (n = 95) with recurrent type of major depression according to DSM-IV criteria and sex- and age-matched controls (n = 190) were sent questionnaires investigating symptoms of IBS [Gastrointestinal Symptom Rating Scale (GSRS)-IBS] and symptoms of anxiety and depression [Hospital Anxiety and Depression Scale (HADS)]. Medical records were checked over a 10-year period for chronic somatic symptoms or diseases. Seventy-three patients with unipolar disorder (mean age 63.6 years SD 13.8; range 23-86 years) and 156 controls (mean age 59.2 years SD 11.6, range 21-85 years) responded. Patients with recurrent depression had higher GSRS-IBS scores and showed a strong correlation between symptoms of IBS and anxiety-depression (r(s) = 0.54; P < 0.001). IBS symptoms were also associated with multiple pain symptoms, higher health-seeking behaviour and selective-serotonin-reuptake inhibitor intake. However, patients with recurrent depression (n = 46) in remission (HADS-Depression score <8) did not have more symptoms of IBS than controls (GSRS-IBS median score 6.0 vs 6.5; P = 0.46). There is a strong association between symptoms of IBS and symptoms of anxiety and depression, whereas depressive patients in remission do not have more IBS symptoms than controls.     

Antidepressants may not assist recovery in practice: a naturalistic prospective survey.

A total of 130 people attending psychiatric hospitals within 6 months of onset or relapse of an episode of depressive disorder were interviewed about their symptoms and treatment at the time of their initial contact. After a mean 4-month interval, 119 were reassessed to test the hypothesis that patients treated with antidepressants would be significantly more likely to be clinically improved compared with those untreated. Severity and duration of the episode emerged as the only significant clinical predictors of clinical improvement. Patients on treatment with antidepressants at the start of the study showed a nonsignificant trend for a lesser degree of clinical improvement, even when clinical severity and compliance were taken into account. Those who were not commenced on treatment until later in the study also fared no better than those who were never prescribed antidepressants. The effect of low doses of antidepressants (almost always a tricyclic) appeared to be less beneficial than either higher doses or clinical management without antidepressant drugs. The need for further experimental and naturalistic studies conducted over various periods of time and the implications for clinical practice, medical audit and the appropriate use of health outcome indicators are discussed.     

抗抑郁剂在脑卒中患者中的预防性应用

目的观察预防性应用抗抑郁剂对脑卒中后抑郁(PSD)发生率及神经功能康复的影响。方法64例脑卒中患者随机分成两组,分别接受帕罗西汀与安慰剂治疗,采用改良爱丁堡斯堪的那维亚评分量表(MESS)和日常生活能力量表(ADL)评定脑卒中患者治疗前及治疗后神经功能缺损程度及日常生活能力;治疗结束时评定患者的PSD发生率。结果与安慰剂对照组相比,在治疗结束时,帕罗西汀组患者的MESS、ADL得分分别为11.1±4.3,27.6±4.8,低于安慰剂组的13.6±3.2及32.8±4.1;帕罗西汀组患者的PSD发生率为10.7%,亦低于对照组的41.4%,差异均具有统计学意义。结论预防性应用抗抑郁剂可以降低PSD发生率,并有利于脑卒中患者的神经功能康复。     

Effects of chronic antidepressant treatment on α1- and α2-adrenoceptors in the rat anococcygeus muscle

Summary The effects of a single administration (48 hours) and of chronic (14 days) treatment with tricyclic (desipramine, nortryptiline) and nontricyclic (mianserin, nomifensine) antidepressant drugs on responses of the isolated anococcygeus muscle to the ₂-adrenoceptor agonist xylazine (inhibition of contraction to field stimulation at 1 Hz) and to the ₁-adrenoceptor agonist phenylephrine (contraction of the muscle) have been studied.Of the drugs used only desipramine and nortryptiline administered chronically reduced the responsiveness of the anococcygeus muscle to phenylephrine suggesting a desensitization of postsynaptic ₁-adrenoceptors. Long-term but not acute administration of antidepressants resulted in significant decrease in sensitivity of presynaptic ₂-adrenoceptors to xylazine. These results show that the adaptative changes of -adrenoceptors in the rat anococcygeus muscle following long-term administration may depend on the efficiency to inhibit the neuronal uptake and the ability to antagonize ₁-adrenoceptors.     

Chronic treatment with desipramine caused a sustained decrease of 3,4-dihydroxyphenylglycol-sulphate and total 3-methoxy-4-hydroxyphenylglycol in the rat brain

Summary The 2 major metabolites of norepinephrine (NE), 3,4-dihydroxyphenylglycol-sulphate (DOPEG-SO₄) and free plus conjugated 3-methoxy-4-hydroxyphenylglycol (total-MOPEG), both their endogenous concentrations and their accumulation from the NE-precursors ³H-tyrosine or ³H-dopamine, were determined in the whole rat brain to assess the effect of chronic treatment with desipramine (DMI), imipramine and amitriptyline. DOPEG-SO₄ was decreased 2 h and 24 h after the last administration of DMI (10 mg/kg twice daily for 4, 10 or 20 days) or imipramine (10 mg/kg twice daily for 10 days). When measured within 24 h after the last dose of DMI or imipramine, several schedules resulted in reduced accumulation of total-³H-MOPEG and ³H-NE, while ³H-NE and MOPEG were unchanged in the remaining schedules. These results indicate that DMI retains its ability to decrease NE-turnover over a period of 20 days of treatment. Forty-eight hours or 72 h after the last administration of desipramine and imipramine an overshoot was observed in NE-metabolism, consisting of increased levels of total-³H-MOPEG and endogenous total-MOPEG; DOPEG-SO₄ was some-times concomitantly increased. The overshoot was more consistent after 20 or 10 days of treatment than after 4 days of treatment. This finding, together with a tendency to partial tolerance to the metabolite decreasing effects of DMI, indicate that adaptive changes occur in the NE system after treatment for 10–20 days with DMI or imipramine.Abbreviations Used NE norepinephrine - DOPEG 3,4-dihydroxyphenylglycol - DOPEG-SO₄ DOPEG sulphate ester - MOPEG 3-methoxy-4-hydroxyphenylglycol - total-MOPEG free plus conjugated MOPEG - DOPAC 3,4-dihydroxyphenylacetic acid - HVA homovanillic acid - NM normetanephrine - DA dopamine - DMI desipramine     

抗抑郁药的药理特征与临床评价

目的 :研究抗抑郁药的药理特征与临床评价 ,以期为临床合理应用提供参考。方法 :查阅近期相关国内、外文献 ,对各类抗抑郁药的药理特征与临床评价进行介绍。结果与结论 :抗抑郁药品种类繁多 ,临床施治应根据抑郁类型、靶症状、患者躯体状况和药物不良反应等情况个体化用药     

1999～2002年上海精神卫生中心抗抑郁药应用分析

目的：了解上海市精神卫生中心近4年来抗抑郁药的用药变化情况，探讨其使用特点及趋势。方法：统计分析了该院在1999—2002年使用抗抑郁药的品种、用量、金额及用药频度、年平均增长率和药品日耗费用等情况。结果：该院在近4年中使用的抗抑郁药金额平均年增长率为13．52％。5-羟色胺再摄取抑制剂在4年中年平均增长率达18．78％，用药金额排位前2名。杂环类抗抑郁药物在用药频度上排位前列。新上市的抗抑郁药用药金额年平均增长率为23．88％，但其使用频度仍排位在后。国产氟西汀类药物的上市，使药品的日耗费用下降，用药金额及频度却大幅度上升。结论：在抗抑郁药使用中还存在用药较为集中的问题。合理选用抗抑郁药，除了考虑疗效确切、不良反应较少外，还需考虑价格适中。     

金丝桃提取物对应激动物模型的抗抑郁作用及其机理研究

[目的]探讨金丝桃提取物(EHP)的抗抑郁作用及其作用机制。[方法]选取了小鼠强迫游泳应激实验;小鼠尾悬吊应激实验;大鼠慢性应激抑郁模型脑内单胺类神经递质测定实验,研究EHP抗抑郁作用及其作用机制。[结果]EHP(320mg/kg、160mg/kg)能显著缩短强迫游泳小鼠及尾悬吊小鼠的不动时间(P<0.05);EHP(320mg/kg、160mg/kg)能显著提高慢性应激抑郁模型大鼠大脑内单胺类神经递质及其代谢物的含量(P<0.05).结论金丝桃提取物具有一定的抗抑郁作用,其抗抑郁作用可能与增加脑内单胺类神经递质的含量有关。     

2-三氟甲基噻吨-9-酮的制备

邻巯基苯甲酸和对氯三氟甲苯缩合得到邻-(对三氟甲基苯硫基)苯甲酸,再经浓硫酸脱水闭环得到抗抑郁药氟哌噻吨的中间体2-三氟甲基噻吨-9-酮,总收率49%.