帕罗西汀合并氟哌噻吨美利曲辛治疗神经症的躯体形式障碍

目的：探讨躯体形式障碍患者的有效治疗方法及安全性。方法：60例躯体形式障碍患者随机分为A组与B组各30例，均采用帕罗西汀片治疗，A组同时加服氟哌噻吨美利曲辛片，共治疗8周。治疗前和治疗后第2、4、6、8周末分别采用汉密顿抑郁量表（HAMD）、汉密顿焦虑量表（HAMA）、副反应量表（TEss）评分。结果：与治疗前比较，治疗2、4周时HAMD、HAMA评分，A组明显下降（P〈0．01），治疗4周时B组开始明显下降（P〈0．001）；治疗8周时2组均显著下降（P〈0．01）。2组患者出现副反应轻微，无因药物反应而中断治疗，安全性良好。结论：帕罗西汀与氟哌噻吨美利曲辛治疗躯体形式障碍的疗效及安全性类似，但帕罗西汀合并氟哌噻吨美利曲辛治疗躯体形式障碍则起效更快。     

帕罗西汀与氟西汀治疗抑郁症的疗效比较

目的：评价国产帕罗西汀与氟西汀治疗抑郁症的临床效果和安全性。方法：将60例抑郁症病人随机分为两组：A组和B组．每组30例。A组采用国产帕罗西汀治疗；B组采用氟西汀治疗。两组均治疗6周。两组采用汉密尔顿抑郁量表（HAMD）评定疗效；用副反应量襄（TESS）评定副反应。结果：A组总有效率为76．7％，B组总有效率为80．0％，两组比较。差异无统计学意义（P〉0．05）；两组治疗后HAMD评分均有明显下降（P均〈0．01）。结论：国产帕罗西汀与氟西汀治疗抑郁症疗效相当，且安全。     

A double-blind study of the efficacy of venlafaxine extended-release, paroxetine, and placebo in the treatment of panic disorder

To date, no large-scale, controlled trial comparing a serotonin-norepinephrine reuptake inhibitor and selective serotonin reuptake inhibitor with placebo for the treatment of panic disorder has been reported. This double-blind study compares the efficacy of venlafaxine extended-release (ER) and paroxetine with placebo. A total of 664 nondepressed adult outpatients who met DSM-IV criteria for panic disorder (with or without agoraphobia) were randomly assigned to 12 weeks of treatment with placebo or fixed-dose venlafaxine ER (75 mg/day or 150 mg/day), or paroxetine 40 mg/day. The primary measure was the percentage of patients free from full-symptom panic attacks, assessed with the Panic and Anticipatory Anxiety Scale (PAAS). Secondary measures included the Panic Disorder Severity Scale, Clinical Global Impressions--Severity (CGI-S) and--Improvement (CGI-I) scales; response (CGI-I rating of very much improved or much improved), remission (CGI-S rating of not at all ill or borderline ill and no PAAS full-symptom panic attacks); and measures of depression, anxiety, phobic fear and avoidance, anticipatory anxiety, functioning, and quality of life. Intent-to-treat, last observation carried forward analysis showed that mean improvement on most measures was greater with venlafaxine ER or paroxetine than with placebo. No significant differences were observed between active treatment groups. Panic-free rates at end point with active treatment ranged from 54% to 61%, compared with 35% for placebo. Approximately 75% of patients given active treatment were responders, and nearly 45% achieved remission. The placebo response rate was slightly above 55%, with remission near 25%. Adverse events were mild or moderate and similar between active treatment groups. Venlafaxine ER and paroxetine were effective and well tolerated in the treatment of panic disorder.     

帕罗西汀联合心理治疗对脑梗塞后抑郁的疗效观察

目的:观察帕罗西汀联合心理治疗对脑梗塞后抑郁及神经功能康复的影响。方法:随机将62例脑梗塞患者分为治疗组(帕罗西汀联合心理治疗)和对照组(帕罗西汀治疗),在治疗前和治疗4周后采用汉密顿抑郁量表(HAMD)评定抑郁障碍发生情况,神经功能缺损量表评定神经功能缺损程度。结果:治疗组治疗后HAMD评分(12.6±6.1)分,显著低于治疗前(25.3±11.2)分(P<0.01)及对照组(18.6±7.3)分(P<0.05),两组抑郁疗效有统计学差异(P<0.05);治疗组治疗后神经功能缺损程度评分(10.8±7.5)分,显著低于治疗前(24.9±7.5)分(P<0.05)及对照组(15.2±4.9)分(P<0.05),两组神经功能康复疗效经Ridit比较有统计学差异(P<0.05)。结论:帕罗西汀联合心理治疗可明显改善脑梗塞后抑郁程度,并能促进神经功能康复。     

文拉法辛缓释剂与帕罗西汀治疗抑郁症的对照研究

目的:探讨文拉法辛缓释剂和帕罗西汀治疗抑郁症(MD)的疗效和安全性。方法:将57例MD患者随机分为文拉法辛缓释剂组(28例)和帕罗西汀组(29例),并给予相应的药物治疗6周。分别于治疗前、治疗后3、7、10、14 d及6周应用汉密尔顿抑郁量表17项(HRSD)进行评定;治疗3、7、10及14 d应用治疗过程中出现的症状量表(TESS)评估药物不良反应。结果:治疗14 d分组与时间存在交互作用(F=6.608,P=0.001)。文拉法辛缓释剂组治疗第7 d起、帕罗西汀组治疗第10 d起HRSD评分较治疗前明显下降(P均0.01);治疗7及14 d文拉法辛缓释剂组HRSD评分明显低于帕罗西汀组(P均0.01);6周后两组间疗效及药物不良反应率差异无统计学意义。结论:与帕罗西汀相比,文拉法辛缓释剂治疗MD起效快,但疗效和不良反应相当。     

Electroconvulsive therapy vs. paroxetine in treatment-resistant depression — a randomized study

Failure to respond to adequate pharmacological treatment for major depression is now the most common indication for the use of electroconvulsive therapy (ECT). The advantages of ECT with respect to both speed and quality of response are clinically important issues, but surprisingly few studies have examined the efficacy of ECT in relation to newer antidepressant agents such as selective serotonin reuptake inhibitors (SSRIs). A total of 39 subjects with major depression and with at least two failed antidepressant trials (mean 4.9 trials) were randomized to either paroxetine treatment (n= 18) or right unilateral (RUL) ECT (n=21). Up to the end of the study treatment we found a reduction in the HAMD score of 59% for the ECT group and of 29% for the paroxetine group (P<0.001 paired t-test). In the ECT group, 71% of subjects fulfilled the response criteria (at least a 50% decrease in total HAMD score). The present study found ECT to be superior to paroxetine in medication-resistant major depression, in terms of both degree and speed of response.     

Brysocarpus coccineus (Schum & Thonn) root reinstates sexual competence and testicular function in paroxetine‐induced sexual dysfunction in male Wistar rats

The effects of aqueous extract of Brysocarpus coccineus roots (AEBCR) were studied on sexual behaviour and testicular function of paroxetine‐induced sexual dysfunction (SD) in male rats. Ninety, sexually matured male rats (150.88 ± 5.53 g) were assigned into two groups: A and B. Fifteen SD animals from group B were each allotted to B1, B2, B3, B4 and B5 and received distilled water (DW), Powmax M (7.14 mg/kg body weight, b.w.) 50, 100 and 150 mg/kg b.w of AEBCR, respectively, for 7 days while the non‐SD animals (group A) received DW. Eleven secondary metabolites were present in AEBCR. The lowered (p < .05) ejaculation frequency, penile erection index and penile grooming, higher mount and intromission frequencies, prolonged (p < .05) latencies of mount, intromission, ejaculation, and post‐ejaculatory interval, reduced (p < .05) serum luteinising hormone, follicle stimulating hormone, testosterone, nitric oxide and testicular function indices, degenerated seminiferous tubules and low luminal spermatozoa contents by paroxetine were significantly (p < .05) attenuated and/or reinstated by AEBCR and Powmax M. The restoration of androgen‐dependent sexual and testicular functions in SD male rats by AEBCR validates its folkloric use as aphrodisiac. Clinical studies are desirable to ascertain the efficacy of AEBCR in SD.     

西地那非联合帕罗西汀治疗难治性早泄

目的评价两地那非联合帕罗西汀治疗难治性早泄的临床疗效。方法评估指标：早泄指数(PE) 0～8分(没有=0分,几乎每次=8分),阴道内射精潜伏期评分(1VELT评分)0～3分(超过5min=0分,小于lmin=3分),并记录配偶性交满意频度(SSR)。本组共28例,口服帕罗西汀片剂20mg,每天1次,连续4周为1疗程,性交前2～3h口服两地那非50mg；疗程共3次(持续约4月余),全部病例完成用药并获随访。用药前及3月后分别评估病人早泄指数、IVELT评分,记录阴道内射精潜伏时间和配偶性交满意频度。结果治疗前早泄指数平均为5．69±0．13,IVELT评分为2．81±0．21,治疗后早泄指数平均为1．77±0．22,IVELT为0．16±0．36。治疗前后比较差异均有统计学意义(P＜0．01)。早泄改善者共26例,总有效率为92．86%,其中22例(78．26%)显效。不良反应未经特殊处理自动缓解。结论两地那非与帕罗西汀联合应用能明显改善难治性早泄患者的临床症状。     

帕罗西汀对腹泻型肠易激综合症的疗效观察

目的：观察帕岁西汀对腹泻型肠易激综合征（D—IBS）的疗效。方法：按罗马Ⅱ诊断标准选择45例腹泻型D—IBS患者，给予帕岁西汀10mg／d，疗程12周。治疗前后分别评定D-IBS主要症状、排便频率、粪便性状、汉密尔顿抑郁量表（HAMD）和汉密尔顿焦虑量表（HAMA）。结果：42例患者完成研究，胃肠道主要症状、HAMD、和HAMA评分均明显减低，治疗前后差异有显著性（P〈0．01）。大便次数、性状及腹痛在治疗1周后即明显缓解（P〈0．05），而抑郁、焦虑及精神状态的改善在2周后统计学意义（P〈0．05）。以上观察指标评分呈逐周下降趋势，按意图治疗（ITT）和按方案（PP）分析，治愈率为81．0％，总有效率为100％。结论：帕罗西汀能明显缓解胃肠道症状，改善精神状态，但二者并不完全同步。     

抑郁症的中医治疗

目的：观察中药舒郁散治疗抑郁症的疗效及安全性，并与西药帕罗西汀进行对比研究。方法：采用美国1994年心理精神病学会的抑郁症诊断标准，对确诊为抑郁症的患者采用汉密尔顿抑郁量表(HAMD)，积分≥17分，临床表现综合评分(CGl—S)≥4．0的65例患者纳入临床观察，随机分为中药舒郁散治疗组及西药帕罗西汀治疗组进行对比研究，观察治疗前后的汉密尔顿抑郁量表，临床表现综合评分(CGI—S)的积分变化来评定疗效；同时观察两组治疗后患者临床不良反应的发生率，以评定两种药物治疗的安全性。结果：两组治疗前、后的自身积分变化比较差异有显著性意义，中医治疗组的有效率为68．75％，西医治疗组的有效率为78．78％，两组间有效率的比较差异无显著性意义，西医治疗组有36．4％的患者出现副作用，中医治疗组有12．5％的患者出现副作用，两组间不良反应发生率的比较差异有显著性意义。结论：舒郁散治疗抑郁症有效，虽然帕罗西汀比中药舒郁散治疗抑郁症有效率高，两组间统计差异无显著性意义，但中药舒郁散比帕罗西汀更安全。