草酸依地普仑的合成

目的：合成草酸依地普仑。方法：以5-氰基苯酞为起始原料，经亲核加成、水解、化学拆分、环化和成盐等反应制得抗抑郁药草酸依地普仑。结果：以5-氰基苯酞计，总收率为13．6％。结论：该方法原料价廉易得，反应条件温和，操作简便，适合工业生产。     

Heart rate variability and treatment outcome in major depression: A pilot study

Variations in heart rate variability (HRV) have been associated with major depressive disorder (MDD), but the relationship of baseline HRV to treatment outcome in MDD is unclear. We conducted a pilot study to examine associations between resting baseline HRV and MDD treatment outcome. We retrospectively tested several parameters of HRV in an MDD treatment study with escitalopram (ESC, N = 26) to generate a model of how baseline HRV related to treatment outcome, and cross-validated the model in a separate trial of MDD treatment with Iyengar yoga (IY, N = 16). Lower relative power of very low frequency (rVLF) HRV at baseline predicted improvement in depressive symptoms when adjusted for age and gender (R² > .43 and p < 0.05 for both trials). Although vagal parasympathetic measures were correlated with antidepressant treatment outcome, their predictive power was not significant after adjusting for age and gender. In conclusion, baseline resting rVLF was associated with depression treatment outcome in two independent MDD treatment studies. These results should be interpreted with caution due to limited sample size, but a strength of this study is its validation of the rVLF predictor in an independent sample. rVLF merits prospective confirmation as a candidate biomarker.     

Effects of selective serotonin reuptake inhibitors on motility of isolated fallopian tube

Selective serotonin reuptake inhibitors (SSRIs) affect the smooth muscle cells acting on voltage‐dependent channels for Na⁺, K⁺ and Ca²⁺, but their action is tissue and species specific. The aim of our study was to investigate effects of selective serotonin reuptake inhibitors on motility of the isolated fallopian tubes. Isolated preparations of isthmus and ampoule were taken from fallopian tubes of 20 women during hysterectomy due to uterine fibroids and then tested for reactivity on increasing concentrations of selective serotonin reuptake inhibitors. Escitalopram (from 0.9 × 10^?9 M/L to 1.4 × 10^?6 M/L) produced concentration‐dependent increase of spontaneous contractions of the isolated ampulla (EC50 = 1.20 ± 1.06 × 10^?8 M/L, r = 0.580, P < 0.05) (F = 2.980, df₁ = 6, df₂ = 28, P < 0.05). Paroxetine (from 1.2 × 10^?9 M/L to 5.1 × 10^?5 M/L) produced concentration‐dependent increase of spontaneous contractions of the isolated isthmus (EC50 = 7.01 ± 3.50 × 10^?8 M/L, r = 0.500, P < 0.05) (F = 2.350, df₁ = 9, df₂ = 40, P < 0.05). The SSRIs differ among themselves in regard to their potential to affect motility of the fallopian tubes. Escitalopram and paroxetine have clear stimulating effect which may interfere with functioning of the fallopian tubes, and potentially impair fertility if taken by women in reproductive period of life. The other SSRIs tested in the study did not produce significant effect throughout the concentration range used in the experiments.     

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。     

丹栀温胆汤联用艾司西酞普兰治疗脑卒中后抑郁临床研究

目的 :观察丹栀温胆汤加减联用艾司西酞普兰对脑卒中后抑郁(PSD)患者的临床疗效及安全性。方法 :选取确诊患者76例,按先后顺序分为治疗组和对照组各38例,治疗组用丹栀温胆汤加减联用艾司西酞普兰治疗,对照组单用艾司西酞普兰治疗,共观察6周。采用汉密尔顿抑郁量表(HAMD)在治疗前及治疗后第2周、4周、6周末评分以评定疗效,采用美国国立卫生研究院卒中量表(NIHSS)评分评定神经功能缺损程度,不良反应量表(TESS)评分评定不良反应。结果:治疗6周后,治疗组与对照组总有效率分别为92.11%和73.68%,两组间比较差异有统计学意义(P0.05)。两组均能快速改善患者的抑郁症状,自第2周末起HAMD评分显著低于治疗前(P0.01),但治疗组6周末HAMD评分显著低于对照组(P0.05);治疗组自第4周末NIHSS评分显著高于对照组(P0.01),两组TESS量表评分比较差异无统计学意义(P0.05)。结论:丹栀温胆汤加减联用艾司西酞普兰治疗脑卒中后抑郁可显著改善患者的神经功能,疗效可靠,安全性高且不良反应小。     

Risks and benefits of medications for panic disorder: a comparison of SSRIs and benzodiazepines

Introduction: Panic disorder (PD) is a prevalent and disabling anxiety disorder that can be treated effectively. Selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines are among the most frequently prescribed drugs for PD. In this article, the authors review the current evidence on efficacy, adverse events, and limitations of these two treatment options.

Areas covered: MEDLINE/Pubmed and Web of Science databases were searched for open or placebo-controlled trials on SSRIs and/or benzodiazepines in PD treatment.

Expert opinion: The literature search yielded 4,957 articles related to the theme. Of these, 24 articles were included in this review. Despite their usefulness in PD, SSRIs are associated with a delay of several weeks in onset of therapeutic effect and have the potential to exacerbate anxiety and panic early in the treatment course. Benzodiazepines present rapid onset of action, but can cause tolerance and dependence. Despite strong evidence of the effectiveness of SSRIs and benzodiazepines in the treatment of PD, few trials have performed head-to-head comparisons of these two drug classes. Future studies on the pharmacological treatment of PD should make direct comparisons of risks, benefits, and limitations of each group. This could help improve the evidence-based pharmacotherapy of PD.     

草酸艾司西酞普兰预防卒中后抑郁的临床观察

目的观察草酸艾司西酞普兰预防卒中后抑郁症状及神经功能缺损的临床疗效。方法收集保定市第一医院2013年1月—2013年11月符合纳入标准的脑卒中患者98例,随机分为对照组(49例)和治疗组(49例),对照组给予基础治疗。治疗组在对照组治疗基础上,于入院第2天给予草酸艾司西酞普兰片,起始剂量5 mg/d(由护士统一完成半片剂量),早晨口服,1周后渐增至10 mg/d,维持此剂量至2个月,两组基础治疗均为14 d。在治疗前,治疗后1、2个月分别测定抑郁程度HAMD及神经功能缺损NFI评分,并计算两组患者的依从性。结果治疗后,2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,治疗组HAMD及NFI评分均较对照组下降更明显(P<0.05)。治疗1个月后,对照组和治疗组抑郁症发生率分别为38.78%、12.24%,两组比较差异有统计学意义(P<0.05)。治疗后第1、2、4周治疗组患者依从率为95.9%、100%、100%,对照组为85.7%、79.6%、79.6%,两组比较差异具有统计学意义(P<0.05)。结论草酸艾司西酞普兰能有效地降低脑卒中患者抑郁症的发生率,促进卒中后患者神经功能的恢复,并能提高患者的依从性,值得临床推广。     

艾司西酞普兰联合心理干预治疗老年抑郁症对照研究

目的：探讨老年抑郁症患者的临床特征及治疗状况,为临床干预提供依据。方法对66例老年抑郁症患者（老年组）和70例中青年抑郁症患者（对照组）的临床资料进行回顾性分析。结果老年组以焦虑、激越、自杀意念及行为、躯体化等症状为主要表现,伴发躯体疾病发生率显著高于对照组（P＜0．01）;治疗前汉密顿抑郁量表焦虑躯体化、认识障碍、日夜变化、睡眠障碍及绝望感因子分均显著高于对照组（P＜0．05或0．01）,阻滞因子分显著低于对照组（P＜0．01）;两组均以新型抗抑郁剂治疗为主,但老年组联合情绪稳定剂、无抽搐电休克治疗频率显著低于对照组（P＜0．01）。结论老年抑郁症患者多伴有躯体疾病,以焦虑、激越、自杀意念及行为、躯体化等症状为主要表现。临床治疗以单用新型抗抑郁剂治疗为主。     

艾司西酞普兰与帕罗西汀治疗精神分裂症后抑郁障碍对照研究

目的探讨艾司西酞普兰与帕罗西汀治疗精神分裂症后抑郁障碍的临床疗效和安全性。方法将72例精神分裂症后抑郁障碍患者随机分为两组,研究组37例,对照组35例,两组均维持原用抗精神病药物治疗,在此基础上研究组口服艾司西酞普兰治疗,对照组口服帕罗西汀治疗,观察8周。于治疗前及治疗1周、2周、4周、8周末采用汉密顿抑郁量表评定抑郁状况,副反应量表评定不良反应。结果治疗后两组汉密顿抑郁量表评分均较治疗前有显著下降（P〈0．01）,但研究组治疗第1周末较对照组下降更显著（P〈0．01）,其他时段评分两组比较差异均无显著性（P〉0．05）;治疗8周末,研究组有效率为81．1％,对照组为72．3％,两组比较差异无显著性（x2=0．48,P〉o．05）;两组不良反应均较轻微,总体不良反应发生率比较差异无显著性（x2=1．34,P〉0．05）,但研究组性功能障碍发生率显著低于对照组（x2=4．58,P〈0．05）。结论艾司西酞普兰与帕罗西汀均能显著改善精神分裂症后抑郁障碍患者的抑郁症状,总体疗效相当,但艾司西酞普兰起效更快,对性功能影响较小,安全性更高,依从性更好。     

艾司西酞普兰与帕罗西汀治疗抑郁症伴焦虑症状对照研究

目的 探讨艾司西酞普兰与帕罗西汀治疗抑郁症伴焦虑症状的临床疗效及安全性.方法将52例抑郁症伴焦虑症状患者随机分为两组,每组26例,研究组口服艾司西酞普兰治疗,对照组口服帕罗西汀治疗,观察6周.于治疗前及治疗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 治疗后两组汉密顿抑郁量表总分及焦虑/躯体化因子分均较治疗前显著下降(P<0.01),研究组治疗2周末均较对照组下降更显著(t=3.21,2.52,P<0.01);治疗6周末,研究组总有效率88.46%,对照组为84.62%,两组差异无显著性(X2=0.118,P>0.05).两组不良反应均轻微.结论 艾司西酞普兰与帕罗西汀治疗抑郁症伴焦虑症状疗效显著,总体疗效相当,安全性高,依从件好,但艾司西酞普兰起效更快,可作为治疗抑郁症伴焦虑症状的首选药物.