Is There an Advantage to Venlafaxine in Comparison with Other Antidepressants?

The purpose of this article is to compare and contrast the benefits and limitations of antidepressant drugs. Several different classes of antidepressants are available for treatment of major depressive disorder, each with its own benefits and limitations as a result of its pharmacological profile. Tricyclic antidepressants (TCAs) and monoamine oxidase (MAO) inhibitors are effective in a large proportion of depressed patients, but their use is often limited by short- and long-term safety/tolerability problems. Selective serotonin reuptake inhibitors (SSRIs) exhibit comparable efficacy to TCAs in most patients, but may be less effective in certain patients. Additionally, SSRI use may by impacted by clinically significant drug interactions. Venlafaxine is a selective serotonin-noradrenaline reuptake inhibitor (SNRI) with unique pharmacological properties that may enhance its efficacy as well as its safety profile. In clinical trials, venlafaxine exhibits antidepressant activity in a broad range of patients with major depression, including those with melancholia, agitated or retarded symptoms, anxiety symptoms, and refractory or resistant depression. Venlafaxine has shown potential for an early onset of action and offers dose flexibility that may allow recruitment of additional responders at higher dosages. Because of its lack of affinity for muscarinic cholinergic, histaminergic, and alpha₁-adrenergic receptors, venlafaxine has a safety profile that is superior to that of TCAs. Venlafaxine also is devoid of the drug interactions characteristic of SSRIs. © 1997 John Wiley & Sons, Ltd.     

灵参合剂治疗SSRIs抗抑郁药失眠副作用疗效观察

[目的]观察灵参合剂治疗SSRIs抗抑郁药引起失眠副作用的疗效。[方法]将因使用SSRIs抗抑郁药引起失眠的患者随机分为两组,治疗组40例,口服灵参合剂;对照组40例使用硝西泮片治疗。采用匹兹堡睡眠质量指数(PSQI)评价疗效。[结果]两组治疗2周末、4周末,治疗组的入睡时间、睡眠时间等指标比较,差异无显著性(P>0.05)。治疗组痊愈27例,显效9例,好转2例,无效2例,总有效率为95%,显效率为90%;对照组痊愈26例,显效8例,好转3例,无效3例,对照组的有效率为92.5%,显效率为85%。两组疗效相当,差异无显著性意义(P>0.05)。[结论]灵参合剂对SSRIs抗抑郁药所致失眠疗效确切。     

SSRIs/西酞普兰对卒中后认知功能障碍的影响

目的:观察选择性5-HT再摄取抑制剂类药物西酞普兰对患者卒中后认知功能障碍的影响。方法:所有患者为第三军医大学附属西南医院神经内科住院病人,应用简易精神状态量表筛选卒中后认知功能障碍的患者40例,随机分为治疗和对照组,在常规治疗的同时治疗组加西酞普兰片,为每天早餐后口服20mg,连用3个月。在治疗前和治疗后1月、3月使用简易精神状态量表,汉密尔顿抑郁量表,美国国立卫生院卒中量表,Barthel指数评定患者的功能。结果:治疗后治疗组患者的认知功能改善明显优于对照组(19.35±2.85,21.55±3.24,P<0.05)。结论:西酞普兰能改善患者卒中后认知功能障碍。     

Effectiveness of fluoxetine and doxepin in treatment of melancholia in depressed patients

It has been suggested that serotonin reuptake inhibitors (SSRIs) may be less effective than tricyclic antidepressants (TCAs) in treatment of melancholic depression. We treated 36 depressed ambulatory patients with doxepin or fluoxetine in a double-blind, randomized 6-week trial with placebo run-in. Seven patients treated with doxepin and 13 patients treated with fluoxetine met diagnostic criteria for melancholic depression. Average daily dose was 169.4 ± 41.6 mg for doxepin and 36.8 ± 18 mg for fluoxetine. We observed a 50% response rate in both treatment groups, using as outcome criterion reduction of Hamilton Depression Scale Score to less than 10. Regardless of how strict the definition of response, we found fluoxetine to be as effective as doxepin in our group of melancholic outpatients. Depression and Anxiety 7:69–72, 1998. © 1998 Wiley-Liss, Inc.     

A comparison of side effects of selective serotonin reuptake inhibitors and tricyclic antidepressants in older depressed patients: a meta-analysis

OBJECTIVE: To examine the relative tolerability and side effect profile of tricyclic antidepressants and selective serotonin reuptake inhibitors in older depressed people. METHODS: A systematic literature search generated 37 randomised controlled trials of TCAs and SSRIs of which 11 were entered into a meta analysis comparing withdrawal rates and side effect profiles. RESULTS: 537 TCA recipients and 554 SSRI recipients were compared. TCAs had an increased withdrawal rate (RR: 0.24, CI 1.04, 1.47). A similar result was found when comparing classical TCAs (451 patients) (amitriptyline, clomipramine, doxepin and dothiepin) with SSRIs (466 patients) (RR 1.30 CI: 1.02,1.64). These findings were reflected in the increased TCA prevalence of side effects including dry mouth, drowsiness, dizziness and lethargy. No differences were found when comparing TCA related drugs (mianserin and trazadone) with SSRIs (RR 1.07 CI 0.43, 2.70). CONCLUSIONS: Despite the relative low prevalence of side effects associated with SSRIs a significant minority of older people find these drugs intolerable and experience nausea, vomiting, dizziness and drowsiness. We conclude that TCA related drugs are comparable to SSRIs in terms of tolerability and may offer an alternative when SSRIs are either contra-indicated or clinically unacceptable.     

Delayed mood transitions in major depressive disorder

The hypothesis defended here is that the process of mood-normalizing transitions fails in a significant proportion of patients suffering from major depressive disorder. Such a failure is largely unrelated to the psychological content. Evidence for the hypothesis is provided by the highly variable and unpredictable time-courses of the depressive episodes.     

A benzisothiazole derivative and antipsychotic agent,perospirone, for augmentation of selective serotonin reuptake inhibitors (SSRIs) in refractory obsessive-compulsive disorder (OCD): two patient case series

Even though selective serotonin reuptake inhibitors (SSRIs) are the mainstay of pharamacological treatment for obsessive-compulsive disorder (OCD), as many as 40% of patients do not have an adequate response to these medications. For such SSRI-refractory patients, the augmentation of SSRIs with new-generation antipsychotics that modulate both 5-HT and DA systems has recently been proven effective in controlled augmentation studies. The benzisothiazole derivative perospirone is a new serotonin 5-HT2 and dopamine D2 antagonist available in Japan for the treatment of schizophrenia. As its unique property, perospirone also exhibits 5-HT1A agonistic action. We present two SSRI-refractory OCD patients who showed little improvement with adequate trials of SSRI monotherapy, but exhibited significant improvement in their OCD symptoms after the addition of perospirone to ongoing SSRI treatment. The cases suggest that perospirone augmentation may be an effective and well-tolerated strategy for SSRI-refractory OCD patients. Controlled studies are required to further confirm the efficacy and tolerability of perospirone augmentation for treatment-resistant OCD.     

2013—2017年江苏省荣军医院选择性5-HT再摄取抑制剂类抗抑郁药的使用情况分析

目的 分析江苏省荣军医院2013-2017年选择性5-HT再摄取抑制剂（SSRIs）类抗抑郁药的使用情况,为临床合理用药和优化药品管理提供参考。方法 收集江苏省荣军医院2013-2017年SSRIs的使用资料,利用Excel对药品金额、用药频度（DDDs）、日均费用（DDC）、药品排序比值（B/A）等进行分析。结果 2013-2017年SSRIs类抗抑郁药的销售金额呈上升趋势,艾司西酞普兰、舍曲林的销售金额与DDDs一直处于前列,氟伏沙明增长幅度最快。艾司西酞普兰的DDC相对较高,舍曲林和氟伏沙明的DDC相对较低。氟伏沙明的B/A值较高,其余各药物的B/A值接近于1。结论 2013-2017年江苏省荣军医院SSRIs类抗抑郁药的应用基本合理,药品的疗效是影响临床应用的关键,同时药物的经济性也是重要因素。