艾司西酞普兰的药理及临床评价

艾司西酞普兰为S-西酞普兰，以其较好的疗效及较高的耐受性，在抑郁症及焦虑症等的治疗中得到广泛应用。笔者对其药理作用、药动学特点、临床应用及安全性等方面做一综述。     

Predicting escitalopram monotherapy response in depression: The role of anterior cingulate cortex

Neuroimaging biomarkers of treatment efficacy can be used to guide personalized treatment in major depressive disorder (MDD). Escitalopram is recommended as first‐line therapy for MDD and severe depression. An interesting hypothesis suggests that the reconfiguration of dynamic brain networks might provide important insights into antidepressant mechanisms. The present study assesses whether the spatiotemporal modulation across functional brain networks could serve as a predictor of effective antidepressant treatment with escitalopram. A total of 106 first‐episode, drug‐naïve patients and 109 healthy controls from three different multicenters underwent resting‐state functional magnetic resonance imaging. Patients were considered as responders if they had a reduction of at least 50% in Hamilton Rating Scale for Depression scores at endpoint (>2 weeks). Multilayer modularity framework was applied on the whole brain to construct features in relation to network dynamic characters that were used for multivariate pattern analysis. Linear soft‐threshold support vector machine models were used to separate responders from nonresponders. The permutation tests demonstrated the robustness of discrimination performances. The discriminative regions formed a spatially distributed pattern with anterior cingulate cortex (ACC) as the hub in the default mode subnetwork. Interestingly, a significantly larger module allegiance of ACC was also found in treatment responders compared to nonresponders, suggesting high interactivities of ACC to other regions may be beneficial for the recovery after treatment. Consistent results across multicenters confirmed that ACC could serve as a predictor of escitalopram monotherapy treatment outcome, implying strong likelihood of replication in the future.     

艾司西酞普兰与舍曲林治疗老年脑卒中后抑郁对照研究

目的：探讨艾司西酞普兰与舍曲林治疗老年脑卒中后抑郁患者的临床疗效和安全性。方法将80例老年脑卒中后抑郁患者随机分为两组,均予以神经内科常规治疗及康复治疗,在此基础上研究组口服艾司西酞普兰治疗,对照组口服舍曲林治疗,观察8周。治疗前后采用汉密顿抑郁量表评定临床疗效,副反应量表评定不良反应。结果研究组治疗第1周末汉密顿抑郁量表总分较对照组下降更显著（ P＜0．01）,治疗第8周末研究组显效率80．0％、有效率92．5％,对照组分别为70．0％、90．0％,两组比较差异均无显著性（ P＞0．05）。两组不良反应较轻微,但研究组口干、腹泻不良反应发生率显著低于对照组（P＜0．01）。结论艾司西酞普兰治疗老年脑卒中后抑郁的疗效显著,与舍曲林相当,但艾司西酞普兰起效更快,安全性更高,更适合老年脑卒中后抑郁患者。     

抗抑郁治疗对高血压合并抑郁患者的血压影响的临床观察

目的 探讨合并抑郁的高血压患者在抗高血压治疗基础上行抗抑郁治疗对血压控制影响。方法 选择2014年9月—2015年10月期间在该院就诊的合并抑郁的高血压患者80例,随机均分为A组(抗抑郁治疗组)和B组(对照组),每组40例。在口服非洛地平(5 mg·d-1,每天1次)行抗高血压治疗的基础上,A组予口服艾司西酞普兰(10 mg,每天1次);B组口服安慰剂,每天1次。疗程4周。两组均观察记录每周治疗后患者的重复测量的血压1次,采用汉密尔顿抑郁量表评价抑郁疗效。观察治疗期间患者不良反应的发生情况。 结果 两组治疗后,血压均较基础值明显下降,且维持在正常范围。治疗第4周,A组收缩压和舒张压较B组明显降低,差异有统计学意义(P＜0.05)。治疗4周后,A组汉密尔顿评分较B组明显降低,抑郁症状明显减轻(P＜0.05)。治疗期间,A组体位性低血压与头晕症状较发病率B组明显增加,差异有统计学意义(P＜0.05)。结论 合并抑郁的高血压患者行抗抑郁治疗时,控制抑郁症状效果确切,较单独使用抗高血压药物时血压控制更低,但体位性低血压,头晕等并发症发生率有所增加,临床治疗应根据患者情况做适当调整。     

艾司西酞普兰致低钠血症的文献分析

目的:探讨艾司西酞普兰致低钠血症的发生规律和特点,为临床预防低钠血症提供理论依据。方法:检索2002年至2016年3月国内外学术期刊报道的艾司西酞普兰致低钠血症文献进行统计分析。结果:共有14例报道,其中男性6例,女性8例,年龄≥65岁的老年患者10例(71.4%)。低钠血症发生时间最短为用药后2 d,最长为用药后120 d,10例(71.4%)发生在用药3周内。临床主要表现为头痛、昏迷、意识不清、嗜睡、幻觉、谵妄。所有患者经过停药、限水、补钠治疗后,血钠水平恢复。结论:临床处方时要关注患者的年龄及合并用药,特别是高龄、女性、联合使用利尿剂的患者,应定期监测血钠水平,尤其在用药3周内,以便早期识别低钠血症的发生。     

Verbal memory performance during subchronic challenge with a selective serotonergic and a mixed action antidepressant

OBJECTIVES: Effects of escitalopram 10-20 mg/day and mirtazapine 30-45 mg/day on verbal memory of 18 healthy participants were assessed in a randomized, double-blind, placebo-controlled, three-way crossover trial. METHOD: Each treatment period lasted for 15 days and was separated from the next period by a washout period of at least 13 days. Participants received an evening dose of escitalopram 10 mg, mirtazapine 30 mg, or placebo from days 1 to 7 and an evening dose of escitalopram 20 mg, mirtazapine 45 mg, or placebo from days 8 to 15. On days 2, 9, and 16 a visual verbal memory task was performed measuring drug effects during the acute phase, after dose increase and at steady state. RESULTS: Escitalopram did not affect immediate or delayed verbal memory score throughout treatment. During mirtazapine treatment, participants performed less well in the overall immediate recall score compared to placebo. This impairment was most pronounced in the final trial of the visual verbal learning task. CONCLUSION: Verbal memory was not affected by acute and subchronic escitalopram treatment in healthy participants. Overall immediate verbal memory was slightly but significantly impaired throughout mirtazapine treatment, probably due to a general reduction in overall arousal caused by H1 blockade.     

艾司西酞普兰治疗惊恐障碍对照研究

目的：研究艾司西酞酱兰和舍曲林治疗惊恐障碍的有效性和安全性。方法：65例惊恐障碍患者随机分入艾司西酞普兰组与舍曲林组治疗10周，在治疗前和治疗期间隔周测定惊恐症状评定量表（PASS）、临床总体印象一严重性（CGI—SI）、患者总体评价（PGE），汉密尔顿焦虑量表（HAMA）及每周发作次数，以治疗中出现的症状量表（TESS）评定不良反应。结果：艾司西酞普兰组有效率为96．8％，舍曲林组为93．3％，二药相近。两组患者在治疗10周PASS、CGI—SI、PGE、HAMA的减分率差异无显著性。艾司西酞普兰组的起效时间快于舍曲林组．差异具有显著性（P〈0．01），两组患者均有良好的耐受性。结论：艾司西酞普兰是一种起效快、疗效好、安全性高的治疗惊恐障碍的药物。     

Sexual dysfunction during treatment with serotonergic and noradrenergic antidepressants: Clinical description and the role of the 5-HTTLPR

Abstract

Objectives. Sexual dysfunction (SD) is a frequently reported side-effect of antidepressant treatment, particularly of selective serotonin reuptake inhibitors (SSRIs). In the multicentre clinical and pharmacogenetic GENDEP study (Genome-based Therapeutic Drugs for Depression), the effect of the serotonin transporter gene promoter polymorphism 5-HTTLPR on sexual function was investigated during treatment with escitalopram (SSRI) and nortriptyline (tricyclic antidepressant). Methods. A total of 494 subjects with an episode of DSM-IV major depression were randomly assigned to treatment with escitalopram or nortriptyline. Over 12 weeks, depressive symptoms and SD were measured weekly with the Montgomery–Asberg Depression Rating Scale, the Antidepressant Side-Effect Checklist, the UKU Side Effect Rating Scale, and the Sexual Functioning Questionnaire. Results. The incidence of reported SD after 12 weeks of treatment was relatively low, and did not differ significantly between antidepressants (14.9% escitalopram, 19.7% nortriptyline). There was no significant interaction between the 5-HTTLPR and antidepressant on SD. Improvement in depressive symptoms and younger age were both associated with lower SD. The effect of age on SD may have been moderated by the 5-HTTLPR. Conclusions. In GENDEP, rates of reported SD during treatment were lower than those described in previous reports. There was no apparent effect of the 5-HTTLPR on the observed decline in SD.     

艾司西酞普兰联合意象对话治疗卒中后抑郁的临床疗效观察

目的观察艾司西酞普兰联合意象对话对卒中后抑郁症状及神经功能缺损的临床疗效。方法保定市急救中心2012年1月-2013年7月符合纳入标准的卒中后抑郁患者108例,随机分成药物组（36例）、心理组（36例）和联合组（36例）,分别给予艾司西酞普兰、意象对话治疗及两者联合治疗,在治疗前,治疗后1个月及2个月分别评测抑郁程度HAMD及神经功能缺损NFI评分,比较3组患者的临床疗效。结果经治疗后,3组患者的HAMD及NFI评分均较治疗前明显下降;治疗1个月和2个月后,联合组HAMD及NFI评分均较药物组和心理组下降更明显（P〈0．05、0．01）。结论艾司西酞普兰联合意象对话治疗卒中后抑郁能更加有效地改善患者的抑郁症状,同时能促进卒中后患者神经功能的恢复。