米氮平与阿米替林治疗抑郁症并发慢性疼痛的对照研究

目的 比较米氮平与阿米替林治疗抑郁并发慢性疼痛的效果和不良反应. 方法 68例同时符合抑郁症及慢性疼痛诊断标准的门诊患者随机分为治疗组36例,对照组32例. 患者使用阿普唑仑,剂量控制在0.2 ～0.8 mg•d^-1. 治疗组加用米氮平,第1天15 mg,第4天30 mg,第7天如有必要可增加到45 mg,均为晚餐后1次顿服. 对照组加用阿米替林,第1天50 mg,第4天100 mg,第7天150 mg,分中、晚餐后2次口服. 入组前及治疗后的第7,14,28天分别对患者进行汉密尔顿抑郁量表（HAMD）评分、汉密尔顿焦虑量表（HAMA）评分、不良反应量表（TESS）评分、视觉模拟评分（VAS）评定. 结果 入组时两组患者HAMD、HAMA、VAS评分差异无显著性（P＞0.05）. 治疗第7天,治疗组的HAMD、HAMA、VAS评分迅速下降,与入组时比较差异有极显著性（P＜0.01）,并显著或极显著低于对照组（P＜0.05或P＜0.01）. 治疗第28天两组HAMD、HAMA、VAS评分与入组时比较差异有极显著性（P＜0.01）. 但两组间HAMD、HAMA、VAS评分比较差异无显著性（P＞0.05）. 两组患者有效率差异无显著性（P＞0.05）. 治疗组TESS总分均显著或极显著低于对照组（P＜0.05或P＜0.01）. 结论 米氮平治疗抑郁并发慢性疼痛患者,能迅速控制抑郁和焦虑症状,且能有效地改善或者消除疼痛症状,并且不良反应相对较轻.     

Comparison of the antidepressants reboxetine, fluvoxamine and amitriptyline upon spontaneous pupillary fluctuations in healthy human volunteers

Rationale: Spontaneous fluctuations in the size of the pupil in darkness are a recognised index of ”sleepiness”. Objective: To evaluate the effects of single oral doses of three antidepressants: reboxetine (4 mg), a selective noradrenaline reuptake inhibitor, fluvoxamine (100 mg), a selective serotonin reuptake inhibitor, and amitriptyline (100 mg), a tricyclic antidepressant of known sedative property, upon spontaneous pupillary fluctuations in healthy male volunteers (n=16). Methods: Using the recently developed pupillographic sleepiness test (PST), resting pupil diameter was recorded and two measures of pupillary fluctuations were obtained: total power obtained from a fast Fourier transform and spectral analysis, and the pupillary unrest index (PUI), a cumulative measure of changes in pupil size. Subjects also rated themselves on a battery of visual analogue scales for ”alertness”, ”anxiety” and ”contentedness”. Results: Resting pupil diameter was enhanced by reboxetine, but remained unaffected by the other two antidepressants. Amitriptyline, consistent with its sedative property, increased the total power of pupillary fluctuations and showed a tendency to increase PUI. These pupillary effects of amitriptyline were paralleled by reduced scores on the ”alertness”, ”contentedness” and ”anxiety” self ratings. Neither fluvoxamine nor reboxetine affected pupillary fatigue waves or subjective ratings of ”alertness”. Reboxetine caused a small reduction in subjectively rated ”anxiety”. Conclusions: The mydriatic effect of reboxetine may be due to noradrenaline reuptake blockade in the iris and/or in the central nervous system. The enhancement of pupillary fatigue waves by the sedative antidepressant amitriptyline, but not by the non-sedative antidepressants fluvoxamine and reboxetine, indicates that the PST is a suitable quantitative objective test for the detection of drug-induced changes in the level of arousal. Received: 9 July 1999 / Final version: 26 October 1999     

西比灵与阿米替林防治偏头痛疗效研究

目的：评价西比灵、阿米替林防治偏头痛的疗效。方法：采用Zung氏焦虑自评量表（SAS）及抑郁自评量表（SDS）评价偏头痛患者的焦虑和抑郁程度。将SAS或SDS评分在40分以上的偏头痛患者随机分为西比灵加阿米替林组（A组）、西比灵组（B组）和阿米替林组（C组）；比较各组间疗效的差异。结果：偏头痛患者中有抑郁者69．3％，焦虑者53．7％。治疗30天后，A组SDS及SAS评分均有所降低（P＜0．05），B组和C组则无显著改善（P＞0．05）。A组及B组治疗前后自身对照在发作次数，持续时间及对生活的影响方面评分差异均有统计学意义（P＜0．05）；C组治疗前后比较则没有统计学意义（P＞0．05）。3组间两两对比以A组防治效果最好，B组次之，C组无效。结论：西比灵加阿米替林对偏头痛有预防效果，且对其伴随的情绪障碍改善也有效。     

盐酸文拉法辛缓释片治疗30例抑郁症的疗效分析

目的:探讨盐酸文拉法辛缓释片在临床应用过程中对抑郁症的疗效及安全性。方法:将符合CCMD-3抑郁症诊断标准的患者60例,随机分成两组,每组30例,分别给予盐酸文拉法辛缓释片(研究组)和盐酸阿米替林(对照组)治疗。治疗前及治疗1、2、4、6周末均采用汉密尔顿抑郁量表(HAMD)和汉密尔顿焦虑量表(HAMA)评定临床疗效,用不良反应量表(TESS)评定不良反应。结果:研究组显效率优于对照组(P<0.05),总有效率差异无显著性(P>0.05)。治疗后同期HAMD、HAMA评分,研究组均比对照组下降显著,差异有显著性或极显著性(P<0.05或<0.01);不良反应研究组程度轻,多能自行缓解,对照组程度较重,需调整药物剂量或对症处理。结论:盐酸文拉法辛缓释片治疗抑郁症疗效显著,安全性高,依从性好,但高血压患者应慎用。     

Strain-specific effects of antidepressants on escape deficits induced by inescapable shock

The effects of several antidepressants (desmethylimipramine, amitriptyline and bupropion) on escape deficits induced by inescapable shock were assessed in four strains of mice. The extent of the escape interference engendered by inescapable shock varied across strains of mice. These deficits of escape performance were differentially affected by the drug treatments across strains. Repeated administration of desmethylimipramine eliminated the escape interference in A/J, but did not affect the performance in Balb/cByJ, C57BL/6J or CD-1 mice. Bupropion, in contrast, had a modest effect only in CD-1 mice. Unlike these compounds, the 5-HT reuptake blocker, amitriptyline, was found to influence escape performance irrespective of whether the drug was acutely or chronically applied. It is suggested that (a) the relative contributions of various mechanisms subserving the escape interference may vary across strains of mice, hence accounting for the strain-specific effects of the drug treatments, and (b) various antide-pressants influence performance by affecting different components of the behavioral output, some of which may be apparent after acute treatment while others are expressed only after repeated treatment with the compound.     

帕罗西汀与几种常用药治疗抑郁症的对照研究

抑郁症是复杂的精神疾病,药物干预是缓解抑郁症患者症状、提高患者生活质量的有效手段,帕罗西汀是临床中广泛应用的药物之一。本文对帕罗西汀和文拉法辛、阿米替林、米氮平等药物治疗抑郁症的用药量、疗程、显效率、总有效率、不良反应和起效情况等方面的对照研究作一综述,以评价各药物对抑郁症的疗效及安全性,为临床安全合理用药提供参考。     

氟西汀和阿米替林对大鼠强迫游泳试验的行为表现及脑内信号分子ERK1/2磷酸化水平的影响

目的 观察氟西汀和阿米替林对大鼠强迫游泳试验中各种行为表现及脑内信号分子细胞外调节蛋白激酶(ERK1/2)磷酸化水平的影响. 方法 30只雄性SD大鼠先预游15 min.间隔23h后,按随机数字表法分成3组:氟西汀组、阿米替林组和对照组,每组各10只.氟两汀、阿米替林按20 mg/kg腹腔注射给药,对照组腹腔注射等体积的蒸馏水,1h后进行5 min的游泳测试,录像并记录出现不动行为的潜伏期和不动、游泳及攀抓行为的时间.游泳完毕后将大鼠灌流处死.对脑组织进行磷酸化ERK1/2(pERK1/2)免疫组织化学染色.观察pERK1/2阳性神经元在部分脑区的分布. 结果 (1)阿米替林组不动行为潜伏期明显长于对照组,攀抓行为时间明显长于对照组和氟西汀组,不动行为时间明显少于对照组;氟西汀组游泳行为时间明显长于对照组和阿米替林组;以上差异均有统计学意义(P<0.05).(2)氟西汀组前额皮质、扣带回及边缘前皮质脑区中pERK1/2阳性神经元数目较对照组和阿米替林组明显减少:阿米替林组腹外侧隔核中pERK1/2阳性神经元数目较对照组明显减少;两给药组下丘脑室旁核中pERK1/2阳性神经元数目较对照组均明显减少,其中阿米替林组减少幅度更大:以上差异均有统计学意义(P<0.05). 结论 阿米替林和氟西汀能对大鼠强迫游泳试验的行为表现产生不同影响,二者可能都有降低负性心理应激反应的作用.脑内ERK1/2信号通路可能参与其中.     

阿米替林治疗间质性膀胱炎的临床研究

目的 探讨阿米替林治疗间质性膀胱炎的有效性和安全性. 方法 采用前瞻性研究.间质性膀胱炎患者54例,病程19～72个月,平均(40.7±11.6)个月.口服阿米替林治疗,起始剂量25 mg/次,每晚1次.1周后,若症状不缓解,可加量至50 mg/次;再观察1周,若症状仍不缓解,则可加量至75 mg/次;维持能够缓解症状的最小剂量,总疗程3个月.观察用药前及用药3个月后患者的临床症状(每日排尿次数、最大排尿容量、尿痛程度评分)和O'Leary-Sant间质性膀胱炎问卷表评分及生活质量评分情况.并记录不良反应发生情况. 结果 ①用药3个月后每日排尿次数明显减少,治疗前后分别为(28.5±8.4)和(15.6±3.3)次;最大排尿容量明显增加,治疗前后分别为(108.7±62.2)和(171.0±53.9)ml;尿痛程度评分明显下降,治疗前后分别为6.4±1.5和2.2±1.5,上述指标用药前后相比,差异均有统计学意义(P<0.01).②患者用药3个月后问卷评分和生活质量评分均明显减少,治疗前后分别为26.9±4.0和13.7±5.7及5.5±0.5和2.5±0.6;用药前后比较,差异有统计学意义(P<0.01).③45例在服药第1个月内有不同程度的困倦,43例1个月后自行缓解,2例由于困倦严重且不能缓解而停药.10例服药3个月后体质量增加(5.8±1.8)kg.11例有轻度便秘症状,可以耐受.9例有口干症状,可以耐受.3例出现重度排尿困难,停药后改为其他方法治疗. 结论 阿米替林口服治疗能有效缓解间质性膀胱炎患者的临床症状,改善生活质量,且耐受性及安全性好.     

Effects of acute and chronic anti-panic drug administration on conflict behavior in the rat

The present studies were undertaken to evaluate further the utility of the Conditioned Suppression of Drinking (CSD) conflict pardigm as an animal model for the study of panic disorder and anti-panic agents. In daily 10-min sessions, water-deprived rats were trained to drink from a tube which was occasionally electrified (0.5 mA). Electrification was signalled by a tone. Desipramine (DMI), amitriptyline (AMI), or phenelzine (PHEN) was administered both in acute (10-min pre-treatment) and chronic (twice daily for up to 9 weeks) regimens. Acute administration of DMI, AMI or PHEN over a wide range of doses resulted in no change or a decrease in the number of shocks accepted and a decrease in water intake at higher doses. In contrast, chronic administration of each agent resulted in a gradual (2–4 week latency) increase in the number of shocks received in CSD sessions over the course of several weeks of testing. This time-dependent increase in punished responding in the CSD observed during chronic anti-panic drug treatment parallels the time-dependent reduction in the severity and frequency of panic attacks in panic disorder patients receiving chronic antidepressants. Thus, the CSD paradigm might serve as an animal model for the study of panic disorder and potential anti-panic agents.