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。     

5-羟色胺再摄取抑制剂联合胰岛素治疗躯体形式障碍对照研究

目的探讨高选择性5羟色胺再摄取抑制剂联合胰岛素治疗躯体形式障碍的临床疗效。方法将59例躯体形式障碍患者随机分为A组30例、B组29例，两组均口服高选择性5羟色胺再摄取抑制剂治疗，B组联合胰岛素治疗。疗程6w。于治疗前及治疗第1w、2w、4w、6w末采用汉密顿焦虑量表、汉密顿抑郁量表评定临床疗效。结果治疗6w末A组显效率53．33％，总有效率96．67％；B组分别为86．21％，100％；B组显效率显著高于A组（χ2=7．516，P〈0．01）。两组汉密顿焦虑量表、汉密顿抑郁量表评分治疗第1w末起均较治疗前有显著下降（P〈0．01），第6w末B组较A组下降显著（P〈0．05）。不良反应B组除体重增加较多外，其他因子与A组无显著性差异（P〉0．05）。结论高选择性5羟色胺再摄取抑制剂联合胰岛素治疗躯体形式障碍疗效显著，安全性高，依从性好。     

Effect of chronic administration of selective 5-hydroxytryptamine and noradrenaline uptake inhibitors on a putative index of 5-HT2C/2B receptor function

Chronic treatment with selective 5-HT reuptake inhibitors (SSRI) are therapeutic in obsessive compulsive disorder, depression, anxiety, bulimia nervosa and migraine. In the present study the possibility that SSRI's act by desensitizing 5-HT_2C/5-HT_2B receptors was assessed using a putative in vivo model of 5-HT_2C/5-HT_2B receptor function, mCPP-induced hypolocomotion. mCPP (2,4 and 6 mg/kg i.p. 20 min pretest) reduced locomotion and rears in rats treated acutely or chronically with saline. Acute oral administration of the SSRI's fluoxetine (10 mg/kg), paroxetine (10 mg/kg), or clomipramine (70 mg/kg) or the noradrenaline reuptake inhibitor, desipramine (10 mg/kg), all 1 hr pretest, did not prevent mCPP-induced hypolocomotion. In contrast, chronic treatment with the SSRI's paroxetine and fluoxetine (both 10 mg/kg p.o. daily × 21 days), significantly attenuated the effect of mCPP (4 and 6 mg/kg i.p.) on locomotion and rears 24 hr after the last pretreatment dose. Chronic clomipramine (70 mg/kg p.o. daily × 21 days) also significantly attenuated the effect of mCPP (4 mg/kg i.p.) on rears and tended to reduce the hypolocomotor response. However, chronic treatment with desipramine, (10 mg/kg p.o.daily × 21) had no effect on any of the parameters measured. As chronic fluoxetine and paroxetine did not reduce brain mCPP levels (determined by HPLC 30 min after 4 mg/kg i.p.) the results suggest that chronic SSRI's, but not desipramine, reduce 5-HT_2C/5-HT/_2B receptor responsivity. If this occurs in man, it may mediate or contribute to their reported therapeutic efficacy in depression, anxiety, bulimia, migraine and alcoholism. It may also be of particular relevance to their unique efficacy in OCD.     

老年抑郁症的抗抑郁药物治疗最新进展

老年抑郁症是一种常见的慢性复发性障碍。本文综述新一代的抗抑郁药物治疗老年期抑郁的疗效、安全性以及其他相关问题。     

Selective serotonin reuptake inhibitor use in pregnant women; pharmacogenetics,drug-drug interactions and adverse effects

Introduction: Possible negative effects of selective serotonin reuptake inhibitors (SSRIs) in pregnancy relate to congenital anomalies, negative perinatal events and neurodevelopmental outcome. Many studies are confounded by the underlying maternal disease and by pharmacogenetic and pharmacokinetic differences of these drugs.

Areas covered: The possible interactions of SSRIs and serotonin and norepinephrine reuptake inhibitors with other drugs and the known effects of SSRIs on congenital anomalies, perinatal and neurodevelopmental outcome.

Expert opinion: SSRIs should be given with caution when combined with other drugs that are metabolized by cytochrome P450 enzymes. SSRIs apparently increase the rate of severe cardiac malformations, induce neonatal adaptation problems in up to 30% of the offspring, increase the rate of persistent pulmonary hypertension of the newborn and possibly slightly increase the rate of prematurity and low birth weight. Most neurodevelopmental follow up studies did not find significant cognitive impairments except some transient gross motor delay, slight impairment of language abilities and possibly behavioral changes. The literature on the possible association of SSRIs with autism spectrum disorder is inconsistent; if an association exists, it is apparently throughout pregnancy. The risk associated with treatment discontinuation seems to outweigh the risk of treatment, as severe maternal depression may negatively affect the child’s development. If needed, treatment should continue in pregnancy with the minimal effective dose.     

May selective serotonin reuptake inhibitors (SSRIs) provide some benefit for the treatment of schizophrenia?

Introduction: The treatment of some psychopathological dimensions of schizophrenia (e.g. negative and depressive symptoms) is still challenging for the modest efficacy of atypical antipsychotics. Among pharmacological alternatives, augmentative Selective Serotonin Reuptake Inhibitors (SSRIs) to antipsychotics are frequently prescribed in clinical practice to improve negative/depressive symptoms of schizophrenia patients; however, the data about the efficacy of these molecules on negative, depressive and obsessive-compulsive symptoms of schizophrenia are contrasting.

Areas Covered: Research using the main database sources has been conducted to obtain an overview of the use and efficacy of SSRIs in schizophrenia.

Expert Opinion: Data are too scanty to draw definitive recommendations. In a preliminary way, it can be said that available data do not show effectiveness of SSRIs on depressive symptoms of schizophrenia. Regarding negative symptoms, studies are contrasting, but paroxetine appears to be the most effective compound among SSRIs. Despite limited data, SSRIs appear to be useful for the treatment of obsessive-compulsive symptoms of schizophrenia, particularly fluvoxamine. Close clinical and pharmacological monitoring is needed in case of concomitant administration of antipsychotics and antidepressants for potential serious side effects and influence on plasma drug dosages     

A preliminary randomized double-blind clinical trial on the efficacy of celecoxib as an adjunct in the treatment of obsessive-compulsive disorder

Obsessive-compulsive disorder is a common neuropsychiatric condition. Although a variety of pharmaceutical agents is available for its treatment, psychiatrists have found that many patients cannot tolerate the side effects, do not respond to treatment adequately, and may finally discontinue their treatment. However, augmentation strategies have been shown to have some benefits in the treatment of OCD. These include reducing both the overall cost of treatment and the side effects. The purpose of this study was to assess the efficacy of celecoxib as an adjuvant agent in the treatment of OCD in an 8-week, double-blind, placebo controlled trial. To this end, 25 patients were assigned to a study group and were given fluoxetine 20 mg/day plus celecoxib 400 mg/day (200 mg BID). The control group included 25 patients who were given fluoxetine 20 mg/day plus placebo. Both protocols significantly lowered scores on the Yale-Brown Obsessive-Compulsive Scale over the trial period. The combination of fluoxetine and celecoxib decreased the symptoms of obsessions and compulsions significantly more than fluoxetine plus placebo. The results of this study suggest that celecoxib can be an effective adjuvant agent in the management of patients with OCD; therefore, anti-inflammatory therapies should be further investigated.     

Involvement of endocannabinoids in antidepressant and anti-compulsive effect of fluoxetine in mice

Endocannabinoid analogues exhibit antidepressant and anti-compulsive like effects similar to that of serotonin selective reuptake inhibitors (SSRIs) indicating a parallelism between the effects of serotonin and endocannabinoids. Therefore, the present study was designed to investigate the role of endocannabinoids in the antidepressant and anti-compulsive like effect of fluoxetine using mice model of forced swim test (FST) and marble-burying behavior (MBB). The results revealed that intracerebroventricular injections of endocannabinoid analogues, anandamide, a CB₁ agonist (AEA: 1-20 μg/mouse); AM404, an anandamide transport inhibitor (0.1-10 μg/mouse); and URB597, a fatty acid amide hydrolase inhibitor (0.05-10 μg/mouse) produced antidepressant-like effect dose-dependently, whereas influenced the MBB in a biphasic manner (produced a U-shaped dose-response curve). Fluoxetine (2.5-20 mg/kg, i.p.) dose dependently decreased the immobility time as well as burying behavior. Co-administration of sub-effective dose of fluoxetine (2.5 mg/kg, i.p.) potentiated the effect of sub-effective dose of AEA (0.5 μg/mouse, i.c.v.), AM404 (0.05 μg/mouse, i.c.v) or URB597 (0.01 μg/mouse, i.c.v) in both the paradigms. Interestingly, pretreatment with AM251, a CB₁ antagonist, blocked the effect of fluoxetine in FST and MBB at a dose (1 μg/mouse, i.c.v) that per se had no effect on either parameter. Similar effects were obtained with endocannabinoid analogues in AM251 pretreated mice. However, AM251 increased the burying behavior in MBB at a highest dose tested (5 μg/mouse). None of the treatments had any influence on locomotor activity. Thus, the study indicates an interaction between endocannabinoid and serotonergic system in regulation of depressive and compulsive-like behavior.