艾司西酞普兰与西酞普兰治疗抑郁症对照观察

目的：探讨艾司西酞普兰与西酞普兰治疗抑郁症的临床疗效及安全性。方法将60例抑郁症患者按就诊顺序随机分为艾司西酞普兰组和西酞普兰组,每组30例,分别口服艾司西酞普兰、西酞普兰治疗,观察6周。于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。结果治疗第6周末艾司西酞普兰组总有效率为86.67%,西酞普兰组为83.33%,两组比较差异无显著性(P >0.05)。艾司西酞普兰组治疗第1周末起,西酞普兰组治疗第2周末起汉密顿抑郁症量表总分较治疗前显著降低(P <0.01);治疗第1周末艾司西酞普兰组显著低于西酞普兰组(P <0.01),其他治疗时点两组比较差异无显著性(P >0.05)。艾司西酞普兰组不良反应发生率为43.3%,西酞普兰组为50.0%,两组比较差异无显著性(P >0.05)。结论艾司西酞普兰治疗抑郁症疗效显著,安全性高,与西酞普兰相当。     

心理干预与艾司西酞普兰治疗轻中度抑郁发作对照研究

目的：探讨心理干预与艾司西酞普兰治疗轻中度抑郁发作的临床疗效。方法将120例轻中度抑郁发作患者随机分为两组,研究组（58例）予以心理干预,对照组（62例）口服艾司西酞普兰治疗,治疗过程中脱落病例进入脱落治疗组,予以心理干预联合艾司西酞普兰治疗,观察24周。于治疗前后采用汉密顿抑郁量表评定临床疗效。结果治疗初期研究组脱落率为36．2％,对照组为12．9％,研究组脱落率显著高于对照组（ P＜0．01）。治疗后研究组与对照组汉密顿抑郁量表评分均较治疗前显著下降（ P＜0．05或0．01）,对照组治疗2周、8周、12周末较研究组下降更显著（ P＜0．05或0．01）,治疗24周末研究组与对照组总有效率均显著高于脱落治疗组（P＜0．01）,研究组与对照组比较差异无显著性（P＞0．05）。结论心理干预治疗轻中度抑郁发作虽起效较缓慢,但远期治疗效果显著,与艾司西酞普兰疗效相当。     

艾司西酞普兰对抑郁症患者认知功能的影响：失匹配负电位的评价

实验对30例抑郁症患者及与其年龄、性别、教育程度相匹配的30名健康对照的事件相关电位失匹配性负波进行检测,发现抑郁症患者频率偏离以及时间偏离失匹配负波电位波幅均低于健康对照,说明抑郁症患者存在听觉注意认知加工过程的异常,即认知功能缺陷。经艾司西酞普兰治疗8周后,抑郁症患者的频率偏离以及时间偏离失匹配负波电位波幅明显提高,HAMD量表评分明显降低。表明艾司西酞普兰可改善抑郁症患者的认知功能,失匹配负电位可以作为认知功能状态以及治疗效果评价的神经电生理指标。     

Escitalopram for psychogenic nausea and vomiting: a report of two cases

Psychogenic nausea and vomiting is defined as vomiting without any obvious organic pathology or vomiting with a psychological etiology. The treatment for such a condition is a challenge in clinical practice. The first patient was a 46-year-old married factory worker who was repeatedly hospitalized for recurring bouts of nausea and vomiting. After consultation, she was diagnosed with major depressive disorder. The frequency of nausea and vomiting decreased after treatment with daily doses of 10-20 mg escitalopram. The second patient was a 37-year-old married teacher who had bouts of nausea and vomiting and was also hospitalized repeatedly. She was diagnosed with mixed anxiety-depressive disorder. After treatment with 10 mg/day escitalopram, her episodes of nausea and vomiting decreased. Escitalopram may be an effective treatment for psychogenic nausea and vomiting associated with depression.     

Escitalopram

Escitalopram oxalate (S-citalopram, Lexapro^?), a selective serotonin re-uptake inhibitor antidepressant which is the S-enantiomer of citalopram, is in clinical development worldwide for the treatment of depression and anxiety disorders. Preclinical studies demonstrate that the therapeutic activity of citalopram resides in the S-isomer and that escitalopram binds with high affinity to the human serotonin transporter. Conversely, R-citalopram is ～ 30-fold less potent than escitalopram at this transporter. Escitalopram has linear pharmacokinetics, so that plasma levels increase proportionately and predictably with increased doses and its half-life of 27 – 32 h is consistent with once-daily dosing. In addition, escitalopram has negligible effects on cytochrome P450 drug-metabolising enzymes in vitro, suggesting a low potential for drug–drug interactions. The efficacy of escitalopram in patients with major depressive disorder has been demonstrated in multiple short-term, placebo-controlled clinical trials, three of which included citalopram as an active control, as well as in a 36-week study evaluating efficacy in the prevention of depression relapse. In these studies, escitalopram was shown to have robust efficacy in the treatment of depression and associated symptoms of anxiety relative to placebo. Efficacy has also been shown in treating generalised anxiety disorder, panic disorder and social anxiety disorder. Results also suggest that, at comparable doses, escitalopram demonstrates clinically relevant and statistically significant superiority to placebo treatment earlier than citalopram. Analysis of the safety database shows a low rate of discontinuation due to adverse events, and there was no statistically significant difference between escitalopram 10 mg/day and placebo in the proportion of patients who discontinued treatment early because of adverse events. The most common adverse events associated with escitalopram which occurred at a rate greater than placebo include nausea, insomnia, ejaculation disorder, diarrhoea, dry mouth and somnolence. Only nausea occurred in > 10% of escitalopram-treated patients.     

What to expect from a third step in treatment resistant depression: A prospective open study on escitalopram

Objectives. Only few studies investigated treatment strategies for treatment resistant depression (TRD). The objective of this multicentre study was to evaluate TRD patients who did not respond to at least two antidepressants. Methods. A total of 417 patients, who failed to respond to a previous retrospectively assessed antidepressant (AD1), were firstly included in a 6-week venlafaxine treatment (AD2); secondly, those who failed to respond were treated for further 6 weeks with escitalopram (AD3). Results. Out of 417 patients who had failed to respond to previous treatment (AD1), 334 completed treatment with venlafaxine to prospectively define TRD. In the intent to treat (ITT) population in the first phase of the trial (AD2), responders to venlafaxine were 151 (36.21%) out of which remitters were 83 (19.90%). After phase one, 170 non-responders, defined as TRD, were included in the second phase and 157 completed the course. Of the 170 ITT entering the second phase (AD3), responders to escitalopram were 71 (41.76%) out of which remitters were 39 (22.94%). After the third treatment, patients showed a dropout rate of 7.65% and a rate of presence of at least one serious adverse event of 19.18%. Conclusions. Relevant rates of response and remission may be observed after a third line treatment in patients resistant to two previous treatments. A relevant limitation of this study was represented by the design: naturalistic, non-randomized, open-label, without a control sample and with unblinded raters.     

艾司西酞普兰与文拉法辛治疗首发抑郁症对照研究

目的 探讨艾司西酞普兰与文拉法辛缓释剂治疗首发抑郁症的临床疗效和安全性.方法 将80例抑郁症患者随机分为两组,每组40例,研究组口服艾司西酞普兰治疗,对照组口服文拉法辛缓释胶囊治疗,观察6周.于治疗前及治疗第1周、2周、4周、6周末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 治疗1周末起,两组汉密顿抑郁量表总分均较治疗前有显著下降(P＜0.01),治疗各时段两组汉密顿抑郁量表总分及减分率差异均无显著性(P＞0.05);治疗6周末,研究组痊愈率52.63%、有效率为81.58%,对照组分别为54.05%、78.38%,两组差异无显著性(χ2=0.015、0.120,P＞0.05).两组不良反应均轻微,多出现在用药初期,随着时间的延长均可减轻或缓解,研究组恶心、多汗不良反应发生率显著低于对照组(P＜0.05或0.01),其他不良反应发生率两组差异均无显著性(P＞0.05).结论 艾司西酞普兰与文拉法辛缓释剂治疗首发抑郁症疗效显著,起效快,但艾司西酞普兰安全性更高,依从性更好.     

One‐week escitalopram intake alters the excitation–inhibition balance in the healthy female brain

Neural health relies on cortical excitation–inhibition balance (EIB). Previous research suggests a link between increased cortical excitation and neuroplasticity induced by selective serotonin reuptake inhibitors (SSRIs). Whether there are modulations of EIB following SSRI‐administration in the healthy human brain, however, remains unclear. Thus, in a randomized double‐blind study, we administered a clinically relevant dose of 20 mg escitalopram for 7 days (time when steady state is achieved) in 59 healthy women (28 escitalopram, 31 placebo) on oral contraceptives. We acquired resting‐state electroencephalography data at baseline, after a single dose, and at steady state. We assessed 1/f slope of the power spectrum as a marker of EIB, compared individual trajectories of 1/f slope changes contrasting single dose and 1‐week drug intake, and tested the relationship of escitalopram plasma levels and cortical excitatory and inhibitory balance shifts. Escitalopram‐intake was associated with decreased 1/f slope, indicating an EIB shift in favor of excitation. Furthermore, 1/f slope at baseline and after a single dose of escitalopram was associated with 1/f slope at steady state. Higher plasma escitalopram levels at a single dose were associated with better maintenance of these EIB changes throughout the drug administration week. These findings demonstrate the potential for 1/f slope to predict individual cortical responsivity to SSRIs and widen the lens through which we map the human brain by testing an interventional psychopharmacological design in a clearly defined endocrinological state.     

艾司西酞普兰治疗围绝经期抑郁对照观察

目的：观察艾司西酞普兰联合激素对围绝经期中重度抑郁症的临床疗效。方法：50例围绝经期中重度抑郁症患者随机分为合用组和单用组。合用组给予艾司西酞普兰和替勃龙,单用组给予替勃龙,用Montgomery and Asberg抑郁量表（MADRS）和Kupperman绝经指数（KMI）对患者进行治疗8周观察。结果：完成研究43例,其中合用组22例,单用组21例。合用组有效率90．9％,对照组有效率71．4％。合用组治疗1周后MADRS评分与治疗前差异有显著性,而单用组到第2周与治疗前有差异。治疗第2周时,两组之间MADRS评分差异有显著性,这种差异一直持续到8周末。在KMI改善方面,两组在治疗第1周均比治疗前有显著改善,到第2周时,合用组与单用组间KMI评分差异有显著性,这种差异一直持续到8周末。结论：艾司西酞普兰联用雌激素能够在治疗1周内显著改善患者抑郁症状和KMI,并且能够持续改善患者的症状,这种疗效优于单用雌激素治疗。