肝移植患者抑郁情绪的临床研究

目的了解肝移植病人的抑郁情绪,分析相关因素,寻找有效的治疗办法。方法应用Zung抑郁自评量表对32例肝移植术后患者进行常规筛选,凡Zung抑郁自评量表为抑郁状态者,再进行Hamilton抑郁量表的检查。并对诊断为抑郁状态的患者进行抗抑郁治疗,用盐酸舍曲林50mg/d,连续治疗6周后,再进行上述量表评分及生存质量评分。结果32例患者中,12例Zung抑郁自评量表的粗分>40分,Hamilton抑郁量表评分>24分者3例。经过抗抑郁治疗后,临床症状改善明显,抑郁自评量表评分明显下降,生存质量评分显著升高。结论肝移植术后患者中普遍存在抑郁情绪,经抗抑郁治疗后,对肝移植患者术后生活质量的提高产生了积极的影响。     

Sertraline-induced hypomania: a genuine side-effect

OBJECTIVE: Antidepressants including selective serotonin reuptake inhibitor (SSRI)-associated mania or hypomania has been well documented in the literature but these patients with switch have either mood disorders or various risk factors for bipolar disorder. This case report examines SSRI-induced hypomania in a patient with dissociative disorder and highlights hypomania as a genuine side-effect of sertraline rather than a switch. METHOD: A 23-year-old female patient with dissociative disorder has been described. RESULTS: Hypomanic symptoms emerged during treatment with sertraline at the dose of 50 mg/day after 3-4 days of initiation of therapy and had complete recovery within 7 days after stopping sertraline. CONCLUSION: In the absence of risk factors for manic switch, sertraline-induced hypomania may be a true side-effect of drug.     

Citalopram treatment of paroxetine-intolerant depressed patients

We assessed the tolerability and antidepressant response to citalopram in a group of patients who could not tolerate a recent trial of paroxetine therapy. Sixty-one outpatients with major depressive disorder and a confirmed history of intolerance to paroxetine (mean final dose: 26.7 mg/day) were switched after at least a 1 week washout to citalopram therapy (20 mg/day). During the 6-week, open label treatment protocol, citalopram could be titrated up to a maximum dose of 40 mg/day. Response was evaluated using the Clinical Global Impressions CGI scale, the 24-item Hamilton Rating Scale for Depression, and several other measures of symptoms and quality of life. Fifty-three patients (87%) completed 6 weeks of citalopram therapy (mean intent-to-treat dose: 23.9 mg/day). The specific side effects that were reported to be intolerable during the earlier paroxetine trial typically recurred only less than 30% of the time during citalopram therapy; only 6 patients (10%) dropped out because of adverse events. The intent-to-treat CGI response rate was 56% at study endpoint; 62% of the completers responded. Significant improvement from pretreatment was observed on various symptom measures after two weeks of citalopram therapy. Citalopram therapy was well tolerated, and more than one half of the patients who began treatment improved significantly. Although further work is necessary to assess the relative merits of this within-class switching strategy (as compared to other options), these data provide further evidence that the various selective serotonin reuptake inhibitors do not have interchangeable tolerability profiles.     

Pharmacodynamic studies on the central mode of action of S-adenosyl-L-methionine (SAMe) infusions in elderly subjects,utilizing EEG mapping and psychometry

In a double-blind, placebo-controlled cross-over study, the acute and subacute effects of S-adenosyl-L-methionine (SAMe), or ademetionine, on brain function and behavior of 10 elderly normal healthy volunteers (5 males and 5 females, aged 56-71 years, mean: 59.3 years) were investigated by means of EEG mapping and psychometry. In random order they received infusions of 800 mg SAMe and placebo, administered over 30 minutes for 7 days, with a wash-out period of 3 weeks in between. EEG recordings and psychometric tests were carried out 0, 1, 3 and 6 hours after drug administration on days 1 and 7. Multivariate analysis based on MANOVA/Hotelling T(2) tests demonstrated significant central effects of SAMe as compared with placebo after acute, subacute and superimposed drug administration. Acute SAMe-induced changes were characterized by a decrease in total power, an increase in absolute delta and a decrease in absolute alpha power, further by an increase in relative delta and a decrease in relative alpha power, a slowing of the delta/theta centroid as well as a slowing of the centroid of the total power spectrum. These changes are typical of classical antidepressants of the thymoleptic type such as imipramine and amitriptyline. After one week of daily infusions there was a marked increase in total power, reminiscent of nootropic drug effects. One additional superimposed dosage mitigated these effects in the direction of an antidepressant profile, with the inter-drug differences waning in the 6(th) hour. Our pharmaco-EEG findings suggest both inhibitory and excitatory drug effects underlying the antidepressant properties of SAMe well-documented in clinical trials. Psychometric tests concerning noopsychic and thymopsychic measures as well as critical flicker frequency generally demonstrated a lack of differences between SAMe and placebo, which again reflects a good tolerability of the drug in elderly subjects.     

新型抗抑郁药：米那普仑

米那普仑是一种新型抗抑郁药,对5-羟色胺(5-HT)及去甲肾上腺素(NE)的再摄取具有双重抑制作用,且强度相当。口服米那普仑具有较高的生物利用度和较低的血浆蛋白结合力,大部分以原型或葡萄糖酸苷的形式从尿中清除,与其他药物相互作用少。米那普仑的抗抑郁疗效与三环类相似,可能优于选择性5-羟色胺回收抑制剂(SSRIs),且耐受性良好。每日2次口服,50～150 mg·d~(-1)。该药为抑郁症的药物治疗提供了一种新的选择。     

芳烷醇哌嗪类化合物的合成及抗抑郁活性

目的 研究芳烷醇哌嗪类化合物的合成及抗抑郁活性.方法 哌嗪经甲酰基保护后,与相应的卤代芳烃进行烷基化反应制备芳烷酮哌嗪化合物,再经钠硼氢还原制得芳烷醇哌嗪类目标化合物.通过体外实验测定目标化合物对单胺递质再摄取的抑制活性,并通过小鼠强迫游泳实验和小鼠尾悬挂实验对化合物Ⅲ2进行体内抗抑郁活性研究.结果 合成32个未见文献报道的新化合物,其结构经MS和1H-NMR谱确证.目标化合物Ⅱ5、Ⅲ2、Ⅲ3、Ⅲ5和Ⅲ15对5-羟色胺(5-HT)和去甲肾上腺素(NA)的再摄取均具有较高的抑制活性,其中,化合物Ⅲ2的作用最佳.体内研究结果也显示化合物Ⅲ2在小鼠体内具有很好的抗抑郁活性.结论 化合物Ⅲ2显示出很好的体内外抗抑郁活性,具有深入开发的价值.     

Clinical guidelines for depressive disorders in childhood and adolescence

 Major depressive and dysthymic disorders are recurrent and sometimes persistent unipolar mood disorders, which often present in childhood and adolescence. Depressive episodes may increase in severity and duration with recurrence and are associated with substantial morbidity and risk of suicide. The role of child and adolescent mental health services in early intervention and management is thus of major importance. This paper draws together current research evidence and common clinical practice, in guidelines for the specialist management of depressive disorders in childhood and adolescence. Both psychotherapy and pharmacotherapy have been found to be beneficial for the acute treatment of children and adolescents with depressive disorders. Based on current evidence, psychotherapy may be the first treatment for most depressed youngsters, but antidepressants should be considered for those with severe depression. All patients need continuation therapy, and some will need maintenance treatment. Evidence supporting the efficacy of psychological and psychopharmacological treatments are reviewed. An integration of approaches is suggested as a guideline for treatment planning. Accepted: 15 February 2000     

盐酸度洛西汀的合成

2-乙酰噻吩经Mannich反应、还原、拆分、O-芳基化、N-脱甲基化及成盐反应等反应制得盐酸度洛西汀,总收率21%.     

Clinical Aspects of Tricyclic Antidepressant Poisoning

ABSTRACT Self-poisoning with antidepressant drugs was studied retrospectively in 225 patients admitted to an intensive care unit. Amitriptyline accounted for the overwhelming majority of cases (70%); 106 patients (47%) had taken two or more drugs, in 81 patients (36%) ethanol was found in the blood. Four patients (2%) died. On admission, 111 patients (49%) were unconscious (grade III). A further 30 patients (13%) were in grade IV coma, and of these 27 had taken amitriptyline. Twenty-four hours after admission, 22 patients (10%) remained in coma. Thirty-six patients (16%) required assisted ventilation. Nineteen patients (8%) had convulsions and 6 (3%) aspired stomach contents. Sixty-one patients (27%) had a widened QRS interval exceeding 100 msec, 18 (30%) of them required assisted ventilation, 21 (34%) were in stage IV coma and 15 (25%) had convulsions. This relationship between a widened QRS interval and the severity of intoxication should be considered in the initial assessment of patients with tricyclic antidepressant poisoning.