Impact of Antidepressants on Cytokine Production of Depressed Patients in Vitro

The interplay between immune and nervous systems plays a pivotal role in the pathophysiology of depression. In depressive episodes, patients show increased production of pro-inflammatory cytokines such as interleukin (IL)-1β and tumor necrosis factor (TNF)-α. There is limited information on the effect of antidepressant drugs on cytokines, most studies report on a limited sample of cytokines and none have reported effects on IL-22. We systematically investigated the effect of three antidepressant drugs, citalopram, escitalopram and mirtazapine, on secretion of cytokines IL-1β, IL-2, IL-4, IL-6, IL-17, IL-22 and TNF-α in a whole blood assay in vitro, using murine anti-human CD3 monoclonal antibody OKT3, and 5C3 monoclonal antibody against CD40, to stimulate T and B cells respectively. Citalopram increased production of IL-1β, IL-6, TNF-α and IL-22. Mirtazapine increased IL-1β, TNF-α and IL-22. Escitalopram decreased IL-17 levels. The influence of antidepressants on IL-2 and IL-4 levels was not significant for all three drugs. Compared to escitalopram, citalopram led to higher levels of IL-1β, IL-6, IL-17 and IL-22; and mirtazapine to higher levels of IL-1β, IL-17, IL-22 and TNF-α. Mirtazapine and citalopram increased IL-22 production. The differing profile of cytokine production may relate to differences in therapeutic effects, risk of relapse and side effects.     

艾司西酞普兰治疗老年抑郁症的临床疗效

目的 评价艾司西酞普兰治疗老年抑郁症的疗效和安全性.方法 将90例老年抑郁症患者随机分为3组(每组均30例):艾司西酞普兰组、舍曲林组和文拉法辛组,分别给予艾司西酞普兰、舍曲林和文拉法辛治疗,疗程8周,分别在治疗前和治疗后1,2,4,6,8周,用汉密尔顿抑郁量表(HAMD)评定疗效,用副反应量表(TESS)评定药物不良反应.结果 治疗后,3组HAMD评分均较治疗前明显下降,依次排序为艾司西酞普兰、文拉法辛和舍曲林(P＜0.01).艾司西酞普兰和舍曲林组药物不良反应均较少,2组在第1,6周末差异均无统计学意义(P＞0.05);但艾司西酞普兰较文拉法辛具有更好的耐受性,各种不良反应发生率均明显低于文拉法辛组(P＜0.01).结论 艾司西酞普兰治疗老年抑郁症疗效确切、依从性好,且起效快、不良反应较少.     

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。     

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.     

艾司西酞普兰联合吡拉西坦治疗卒中后认知功能障碍的效果及对患者血清5-HT及NE水平的影响

目的 探讨艾司西酞普兰联合吡拉西坦治疗卒中后认知功能障碍(PSCI)的临床效果.方法 选取2019年2月至2020年12月我科室收治的96例PSCI患者作为研究对象,按照随机数表法将其分为对照组与观察组,每组48例.对照组采用吡拉西坦治疗,观察组采用艾司西酞普兰联合吡拉西坦治疗.比较两组患者的临床效果.结果 观察组的治...     

艾司西酞普兰治疗惊恐障碍的疗效和安全性系统评价

目的系统评价艾司西酞普兰与帕罗西汀治疗成人惊恐障碍的疗效与安全性。方法通过计算机检索及手工检索,以艾司西酞普兰（escitalopram）、帕罗西汀（paroxetine）、惊恐障碍（panicdisorder）为检索词,全面收集中国知网全文数据库（CNKI）、中国维普全文数据库（VIP）、中国生物医学文献数据库（CBMdisc）、万方全文数据库自创刊起关于艾司西酞普兰与帕罗西汀治疗惊恐障碍的临床随机对照试验（RCT）。对最终纳入的RCT按照Cochrane协作网系统评价的方法,严格评价纳入研究质量,对同质性研究采用Revfnan5．0．2软件进行统计分析。结果纳入8个RCT,共包括716名受试对象。治疗第1周、第2周和第4周末艾司西酞普兰组的有效性得分均显著高于帕罗西汀组,有统计学意义[第1周末,MD=-1．93,95％C／（-2．68,-1．19）,P=0．57;第2周末,MD=-4．6,95％C／（-6．51,-2．69）,P〈0．00001;第4周末,MD=-1．2,95％CI（-1．98,-0．43）,P=0．35）;治疗第6周和第8周后艾司西酞普兰组与帕罗西汀组的有效性差异均无统计学意义[第6周末,MD=-0．74,95％CI（-1．53,0．04）,P=0．98：第8周末,MD=-0．55,95％CI（-1．21,0．12）,P=0．72];疗程结束后的终末治愈率艾司西酞普兰组与帕罗西汀组的差异无统计学意义[RR=0．89,95％CI（0．72,1．09）,P=0．59];在分析的所有不良反应报告中,艾司西酞普兰组与帕罗西汀组所有不良反应项目差异均无统计学意义。结论艾司西酞普兰治疗成人惊恐障碍的长期疗效与帕罗西汀相当,但起效快于帕罗西汀,且具有良好的耐受性和安全性。     

Antidepressant Agents in Short Bowel Syndrome

PurposeThis study aimed to determine whether short small intestine modifies antidepressant concentrations.MethodsThe C_ss values and concentration–dose ratios (CDRs) of citalopram or escitalopram, administered orally or intravenously, were determined in patients with short bowel syndrome.FindingsEight patients (6 males and 2 females) were included in the study. High CDRs were obtained in orally treated patients with >180 cm of small bowel and in those with >80 cm of small bowel and 50% of colon. Three patients had low C_ss values, including 1 patient who received intravenous treatment.ImplicationsThe variability of drug absorption and metabolism makes prescribing SSRIs challenging in these patients.     

草酸艾司西酞普兰与米氮平治疗抑郁和焦虑共病的疗效对照

目的比较草酸艾司西酞普兰与米氮平抗抑郁和焦虑的共病作用和不良反应。方法 79例同时符合抑郁症和焦虑障碍诊断标准的门诊和住院患者,HAMD17项总分≥18分≤24分、HAMA总分≥15分≤28分。随机分为草酸艾司西酞普兰组（简称A组）和米氮平组（简称B组）,分别口服草酸艾司西酞普兰和米氮平。研究全程5周。结果草酸艾司西酞普兰、米氮平治疗抑郁和焦虑共病疗效相当（P〉0.05）,其显效率分别为75%、72.2%,且均无严重不良反应,用药安全,耐受性好。结论对具有抑郁和焦虑共病的患者可用草酸艾司西酞普兰。