噻奈普汀与阿米替林治疗抑郁症的对照研究

目的：验证噻奈普汀（Tianeptine)治疗抑郁症的临床疗效和安全性。方法：研究对象符合CCMD－2－R中抑郁发作的诊断标准,经安慰剂清洗3－7天后,被随机分入噻奈普汀治疗组和阿米替林治疗组,治疗剂量分别为37．5mg/日和150mg/日,疗程为6周。疗效评价采用汉密尔顿抑郁量表（HAMD,17项）,蒙哥马利抑郁量表（MADRS）,汉密尔顿焦虑量表（HAMA）和临床疗效总评量表（CGI）,安全性评价采用不良反应清单（AMDP－5）,于治疗前、治疗后第1、2、4、6周各评定一次,实验室检查包括血液常规、肝肾功能和ECG等。结果：共入组26例,噻奈普汀和阿米替林组各13例。根据HAMD减分率评价（减分率≥25％为有效）,6周末噻奈普汀组的HAMD总分平均下降73％,而阿米替林组为48％,判别有显著意义（P＝0．029）。两药的起效时间均在第2周。噻奈普汀的抗焦虑作用在第一周末即有显著效果,6周末的HAMA总分平均下降68％,显著高于阿米替林组的33％（P＝0．0196）。噻奈普汀的不良反应较阿米替林少而轻,结论：噻奈普汀具有肯定的抗抑郁和抗焦虑作用,6周末的临床疗效优于阿米替林,安全性高。     

米氮平和阿米替林治疗躯体形式障碍对照研究

目的探讨米氮平治疗躯体形式障碍的疗效及安全性。方法对80例躯体形式障碍患者分别用米氮平或阿米替林治疗8周。采用汉密尔顿抑郁量表（HAMD）及副反应量表（TESS）评定药物疗效及不良反应。结果米氮平与阿米替林疗效相当,起效快,米氮不良反应轻微。结论米氮平治疗躯体形式障碍疗效肯定,不良反应小。     

Roles of polymorphic enzymes CYP2D6 and CYP2C19 for in vitro metabolism of amitriptyline at therapeutic and toxic levels

The metabolism of the tricyclic antidepressant amitriptyline was studied in vitro in the presence of the main metabolite nortriptyline to simulate the steady state with amitriptyline and nortriptyline present in the ratio 1:1. The metabolism of the active metabolite nortriptyline in the presence of amitriptyline was also studied. The contribution of cytochrome P450 (CYP) 2D6, CYP2C19, and CYP3A4 was assessed by in vitro experiments at therapeutic (5 μM) and toxic (50 μM) concentrations for amitriptyline or nortriptyline with human liver microsomes (HLM). The results indicated that nortriptyline acted as a competitive inhibitor at the steady-state concentrations, lowering the amitriptyline metabolism, and thus changed the importance of different metabolic pathways. When the concentration of substrate amitriptyline was increased from therapeutic level to toxic level (in the steady state), the contribution of CYP2D6 significantly decreased for its demethylation and hydroxylation pathways. However, the contribution of CYP3A4 increased according to the increase in substrate concentration. Similar results could be obtained when nortriptyline was used as substrate in the presence and absence of the precursor amitriptyline. For CYP2C19 in the average HLM, its contribution to metabolism of both amitriptyline and nortriptyline was found to be small. However, it was also found that CYP2C19, in a “high activity” CYP2C19 HLM, was active for N-demethylation of both amitriptyline and nortriptyline and likewise the importance of CYP2C19 decreased when the concentration of substrate was increased. The above results indicate that CYP2D6 or CYP2C19 are generally not likely to be critical enzymes related to accidental intoxication under treatment with amitriptyline, but other contributing factors would be important; for example, low levels of various CYP enzymes and/or drug-drug interactions resulting in inhibition of several CYP enzymes may cause amitriptyline poisoning.     

艾司西酞普兰与阿米替林治疗帕金森病伴抑郁患者的临床疗效

目的 对比分析艾司西酞普兰与阿米替林治疗帕金森病伴抑郁患者的临床疗效.方法 选取2019年04月～2020年04月本院接收的122例帕金森病伴抑郁患者作为本次研究的观察对象.按随机数字表法分为对照组和研究组,每组各61例患者,其中对照组给予阿米替林治疗,研究组给予艾司西酞普兰治疗.比较两组患者治疗前后的汉密尔顿抑郁量表...     

文拉法辛与阿米替林预防偏头痛的对照研究

目的以阿米替林为对照,评价盐酸文拉法辛胶囊预防偏头痛的疗效及安全性。方法79例偏头痛患者随机分成盐酸文拉法辛组（n=40）和阿米替林组（13=39）,盐酸文拉法辛组服用盐酸文拉法辛胶囊75mg／d,阿米替林组服用阿米替林75mg／d,疗程均为3月。治疗前、治疗1个月、2个月和3个月后分剐评价患者的头痛发作次数、严重程度和头痛持续时间,以及治疗后1个月、2个月和3个月的不良反应发生情况。结果经盐酸文拉法辛和阿米替林治疗1月、2月及3月后,患者的头痛发作次数、严重程度及持续时间均显著改善,差异有统计学意义;同时治疗2个月疗效好于1个月,治疗3个月疗效好于2个月;两组患者治疗前后各时点头痛发作次数、严重程度、持续时间比较无统计学差异。但阿米替林不良反应发生率显著高于盐酸文拉法辛,分剐是77．8％和21,差异有统计学意义。结论盐酸文拉法辛预防偏头痛疗效确切,安全性好。     

Paroxetine versus amitriptyline in patients with recurrent major depression: A double-blind trial

INTRODUCTION: Long-term exposure to antidepressants is required to prevent relapses and recurrences in patients with recurrent major depression. Furthermore, a good pharmacological compliance is the key to successful long-term treatment. Since the early phases of a treatment influence long-term compliance and compliance is adversely affected by poorly tolerated treatments, efficacy and tolerability of paroxetine and amitryptiline over 12 weeks were compared as an introduction to the issue of long-term compliance to these two agents. METHOD: A 12-week, randomized, double-blind, doubledummy, parallel-group trial which involved 129 patients with recurrent major depression. RESULTS: Both paroxetine and amitriptyline were effective in controlling the symptoms of depression, as shown by the reduction in HAMD total score and CGI severity-of-illness score at endpoint compared to baseline. There was no statistically or clinically significant difference between the two treatments in terms of efficacy. However, marked numerical differences were noted in tolerability: the percentage of patients who reported treatment-emergent adverse experiences was greater in the amitriptyline group (40.0% vs 28.1%). This difference was mainly due to anticholinergic adverse events, which were six times more frequent with amitriptyline than with paroxetine. CONCLUSION: When compared with amitriptyline, paroxetine should allow patients with recurrent major depression to receive an equally effective treatment with a relatively lower incidence of adverse experiences.     

The effect of guided imagery and amitriptyline on daily fibromyalgia pain: a prospective, randomized, controlled trial

OBJECTIVE: The effectiveness of an attention distracting and an attention focusing guided imagery as well as the effect of amitriptyline on fibromyalgic pain was studied prospectively. METHODS: Fifty-five women with previously diagnosed fibromyalgia were monitored for daily pain (VAS) in a randomized, controlled clinical trial. One group received relaxation training and guided instruction in "pleasant imagery" (PI) in order to distract from the pain experience (n=17). Another group received relaxation training and attention imagery upon the "active workings of the internal pain control systems", "attention imagery" (AI) (n=21). The control group (CG) received treatment as usual (n=17). Patients were also randomly assigned to 50-mg amitriptyline/day or placebo. Some psychological and socio-demographic variables were also measured initially. The slopes of diary pain ratings over a 4-week period were used as the outcome measures. RESULTS: We found significant differences of the pain-slopes between the three psychological conditions (P=0.0001). The pleasant imagery (P<0.005), but not the attention imagery group's slope, declined significantly when compared with the control group (P>0.05). There was neither a difference between the amitriptyline and placebo slopes (main effects, P=0.98) nor a significant amitriptyline x psychological interaction (P=0.76). CONCLUSION: Pleasant imagery (PI) was an effective intervention in reducing fibromyalgic pain during the 28-day study period. Amitriptyline had no significant advantage over placebo during the study period.     

口服加巴喷丁治疗带状疱疹后神经痛的临床观察

目的探讨加巴喷丁治疗带状疱疹后神经痛(PHN)的临床效果与安全性。方法PHN患者20例,经常规药物疗效不佳,在阿米替林(每晚25 mg,睡前服用)的基础上口服加巴喷丁,剂量自300 mg/d起,根据服药后患者疼痛的缓解程度以及不良反应予以调整,每2 d增加剂量1次,直至VAS≤3,然后以此剂量维持,疗程4周。结果服药后,VAS评分均降低、24 h疼痛持续时间减少,而24 h睡眠时间延长;镇痛起效最低剂量为300 mg,1次/d,80%患者每日有效镇痛剂量在1 800~2 400mg,日最大剂量达3 600 mg。结论口服加巴喷丁治疗带状疱疹后神经痛,效果确切,见效快,治疗的稳定性和连续性较好,患者易于耐受且不良反应发生率低,有利于缓解PHN患者的疼痛、延长其睡眠时间并改善其睡眠质量。