安非他酮缓释片治疗抑郁症的随机双盲多中心临床试验

目的评价安非他酮缓释片治疗抑郁症的疗效和安全性。方法采用随机、双盲双模拟、多中心、平行对照(氟西汀),为期6 wk。共入组237例,完成232例,其中安非他酮组117例,氟西汀组115例。2组分别服用安非他酮缓释片300 mg.d-1和氟西汀20 mg.d-1治疗。结果治疗6 wk后,安非他酮组和氟西汀组的汉密尔顿抑郁量表(HAMD)总分减分值分别为(12.45±6.85)与(12.63±6.10)分,有效率分别为69.23%与67.83%,临床痊愈率分别为35.04%和45.22%,2组相比差异均无统计学意义(P>0.05)。非劣效性检验显示,安非他酮组疗效非劣于氟西汀组。2组的不良反应发生率分别为52.14%和52.17%,差异无统计学意义(P>0.05)。结论安非他酮缓释片是一种安全有效的抗抑郁药。     

Pharmacotherapy for smoking cessation: pharmacological principles and clinical practice

Strategies for assisting smoking cessation include behavioural counselling to enhance motivation and to support attempts to quit and pharmacological intervention to reduce nicotine reinforcement and withdrawal from nicotine. Three drugs are currently used as first line pharmacotherapy for smoking cessation, nicotine replacement therapy, bupropion and varenicline. Compared with placebo, the drug effect varies from 2.27 (95% CI 2.02, 2.55) for varenicline, 1.69 (95% CI 1.53, 1.85) for bupropion and 1.60 (95% CI 1.53, 1.68) for any form of nicotine replacement therapy. Despite some controversy regarding the safety of bupropion and varenicline, regulatory agencies consider these drugs as having a favourable benefit/risk profile. However, given the high rate of psychiatric comorbidity in dependent smokers, practitioners should closely monitor patients for neuropsychiatric symptoms. Second-line pharmacotherapies include nortriptyline and clonidine. This review also offers an overview of pipeline developments and issues related to smoking cessation in special populations such as persons with psychiatric comorbidity and pregnant and adolescent smokers.     

Brief Behavioral Therapy and Bupropion for Sleep and Fatigue in Young Adults With Crohn’s Disease: An Exploratory Open Trial Study

Background/AimsSleep disturbances and fatigue are common symptoms amongst patients with Crohn’s disease (CD). The aim of this study was to test the feasibility and effects of a pragmatic, stepped-care intervention for the treatment of poor sleep quality and fatigue in adolescents and young adults with CD.MethodsThis study is a two-phase open trial exploring interventions for sleep and fatigue. After the initial comprehensive assessment which included quantitative measures and an interview to evaluate sleep and physical and mental health, the 12-week intervention consisted of two sequential steps: 1) a brief behavioral therapy for sleep in inflammatory bowel disease (IBD) (BBTS-I; 4 weeks) and 2) adding the psychotropic medication, bupropion sustained release (BUP-SR; 8 weeks), for the subset of subjects continuing to experience fatigue.Results232 CD patients (median age=24, median sex=female) were approached over 18 months, of whom 112 screened positive on the Pittsburgh Sleep Quality Index (PSQI) and multi-dimensional fatigue inventory (MFI), with 68 CD patients completing the more comprehensive baseline assessment. Of the 68 patients, 52 participated in Phase I of the BBTS-I intervention. Following 4-weeks of the BBTS-I, there were significant improvements in sleep quality (p < .001) and fatigue (p < .001). As part of Phase II, of the 52 patients who met fatigue threshold criteria, 33 patients participated in the BUP-SR+BBTS-I arm while 19 participated in the BBTS-I only intervention group. After 8 weeks of Phase II, both intervention groups saw significant further improvement in sleep, fatigue, anxiety and depressive symptoms, but without significant differences between the two intervention groups.ConclusionsA stepped-care approach shows that we can improve sleep disturbance with BBTS-I in CD patients, but fatigue only partially improves. For a subset of patients who chose to add BUP-SR to their behavioral therapy, fatigue improves further but not to a statistically significant effect compared to behavioral therapy alone.     

Bupropion in dermatology: A brief update

There is currently an interest in evaluating the role that antidepressants may play in the treatment of primary cutaneous disorders. It has been proposed that antidepressants could have anti‐inflammatory effects, but the clinical relevance of this effect has not been adequately established. In the case of bupropion, evidence for its specific use in dermatologic conditions currently come only from a pilot study and a case report. While this level of evidence is unlikely to be sufficient to guide clinical practice, the authors of this brief update hope to sort the available information to serve as a guide and provide a structure for future research.     

顶空气相色谱法测定盐酸安非他酮中的有机溶剂残留

目的:建立盐酸安非他酮中有机溶剂残留量的测定方法。方法:采用顶空毛细管气相色谱法,DB-624柱(30 m×0.53mm×3μm),氢火焰离子化检测器(FID),以水为溶剂,程序升温。结果:4种残留溶剂乙醇、异丙醇、二氯甲烷、乙酸乙酯均能完全分离,且线性关系良好。结论:本方法简单、准确、灵敏,重现性好,适用于盐酸安非他酮中有机溶剂残留量的测定。     

安非他酮与文拉法辛治疗抑郁症对照研究

目的:比较安非他酮与文拉法辛治疗抑郁症的临床疗效和安全性。方法:将90例抑郁症患者随机分为安非他酮组(45例)和文拉法辛组(45例),疗程6周。采用汉密尔顿抑郁量表(HAMD)、治疗中出现的症状量表(TESS)评定疗效和安全性。结果:文拉法辛组治疗1周后起效;疗程结束时,两组疗效和HAMD评分差异无显著性,不良反应少而轻。结论:安非他酮与文拉法辛治疗抑郁症疗效相当,文拉法辛起效较快,安非他酮作用温和,依从性好。