米氮平与帕罗西汀治疗抑郁症对照研究

目的比较米氮平与氟西汀治疗抑郁症的临床疗效和安全性.方法 将60例抑郁症患者随机分为米氮平组和帕罗西汀组,分别给予米氮平和帕罗西汀治疗,疗程6周.采用汉密尔顿抑郁量表(HAMD)及治疗中出现的症状量表(TESS)评定疗效和不良反应.结果 米氮平组和帕罗西汀组显效率分别为80.0%和76.7%.两组疗效相仿.但治疗1周后,米氮平组的有效率高于帕罗西汀组.结论 米氮平是一种起效较快,安全、有效的抗抑郁药.     

盐酸帕罗西汀单用与合用小剂量舒必利治疗伴有躯体症状抑郁症患者60例疗效观察

目的探讨盐酸帕罗西汀联合小剂量舒必利治疗伴躯体症状抑郁症的疗效与安全性。方法 60例符合CCMD-3抑郁症诊断标准并伴有明显躯体症状的患者,入组后随机分为两组,分别采用单用帕罗西汀和帕罗西汀联用小剂量舒必利分别治疗6周。采用汉密尔顿抑郁量表（HAMD）于治疗前及治疗后2、4、6周进行疗效评定,采用副反应量表（TESS）评定药物不良反应。结果两组治疗前后HAMD分值比较差异有统计学意义,同时两组间疗效比较也有统计学意义。不良反应评分差异无统计学意义。结论帕罗西汀联合小剂量舒必利治疗伴有躯体症状抑郁症患者与单用帕罗西汀比较具有疗效好、安全性、依从性较高的优点,适合临床应用。     

解郁安神汤结合盐酸帕罗西汀治疗中风后抑郁症40例

目的观察自拟解郁安神汤结合盐酸帕罗西汀胶囊治疗中风后抑郁症的临床疗效。方法将80例患者随机分为治疗组和对照组（各40例）,对照组予盐酸帕罗西汀胶囊,治疗组在此基础上加服自拟解郁安神汤;两组疗程均为8周,观察临床疗效及治疗后汉密尔顿抑郁量表（HAMD）评分、去甲肾上腺素（NE）、5-羟色胺（5-HT）变化情况。结果治疗组、对照组总有效率分别为90.0%、72.5%;组间临床疗效比较,差异有统计学意义（P〈0.05）。两组治疗后HAMD评分明显减少（P〈0.05）;组间治疗后比较,差异有统计学意义（P〈0.05）。两组治疗后5-HT、HE水平均明显提高（P〈0.05）;组间治疗后比较,差异均有统计学意义（P〈0.05）。结论解郁安神汤结合盐酸帕罗西汀胶囊治疗中风后抑郁症疗效明显优于单用盐酸帕罗西汀胶囊,且无明显不良反应。     

艾司西酞普兰与帕罗西汀治疗老年脑卒中后抑郁的对照研究

目的探讨艾司西酞普兰与帕罗西汀治疗老年脑卒中后抑郁的临床疗效及安全性。方法将68例患者随机分为A组和B组,各34例,A组口服草酸艾司西酞普兰,B组口服帕罗西汀。两组于治疗前和治疗后1,2,4,8周末采用汉密尔顿抑郁量表(HAMD)评定疗效,不良反应量表(TESS)评定不良反应。结果两组治疗后HAMD评分均较治疗前显著下降,差异有统计学意义(P<0.01);A组和B组疗效总有效率分别为94.12%和91.18%,不良反应率分别为35.29%和38.24%,差异均无统计学意义(P>0.05)。结论艾司西酞普兰与帕罗西汀治疗老年脑卒中后抑郁的疗效相当,但艾司西酞普兰起效更快,不良反应更轻,适合作为老年脑卒中后抑郁患者的一线用药。     

Regulation of the norepinephrine transporter by chronic administration of antidepressants.

BACKGROUND: Downregulation of serotonin transporter was observed previously after chronic treatment with selective serotonin reuptake inhibitors (SSRIs) but not selective norepinephrine reuptake inhibitors (NRIs). This study investigated if chronic treatment of rats with selective NRIs or SSRIs also affected the norepinephrine transporter (NET). METHODS: Rats were treated for 3 to 6 weeks by osmotic minipumps with either the selective NRIs, desipramine, or the SSRI paroxetine. RESULTS: [(3)H]nisoxetine binding sites as well as [(3)H]norepinephrine uptake were decreased in hippocampus and cortex after treatment with desipramine. By contrast, paroxetine-treated rats showed no alteration in either [(3)H]nisoxetine binding or [(3)H]norepinephrine uptake. NET messenger RNA levels in the locus coeruleus were unchanged by desipramine treatment. CONCLUSIONS: These results demonstrate that the marked decrease in NET density 1) is not a consequence of a decrease in gene expression; 2) was caused only by a selective NRI; and 3) was associated with a parallel decrease in norepinephrine uptake.     

米氮平与帕罗西汀治疗抑郁症对照研究

目的:评价米氮平对抑郁症的疗效和不良反应。方法:将门诊和住院患者56例随机分为两组,分别给予米氮平和帕罗西汀治疗,疗程6周。采用Hamilton抑郁量表(HAMD)和临床疗效总评量表病情严重程度(CGISI)及副反应量表(TESS)评价疗效和不良反应。结果:米氮平组在治疗1、2周末HAMD、CGISI评分显著低于帕罗西汀组(P<0.05)。治疗6周时两组临床疗效相似。两组不良反应均轻微。结论:米氮平是一种安全有效的抗抑郁药,起效较快。     

Relapse prevention by means of paroxetine in ECT-treated patients with major depression: a comparison with imipramine and placebo in medium-term continuation therapy

In-patients with severe major depression were treated in the acute phase with electroconvulsive therapy (ECT) in combination with antidepressants. The drug treatment consisted of two randomized trials which were both extended into the post-ECT continuation phase. Patients with electrocardiological impairment were randomized to either 30 mg paroxetine daily or placebo under blind conditions. Patients without electrocardiological impairment were randomized to either 30 mg paroxetine daily or 150 mg imipramine daily. There was a high level of agreement between the Hamilton Depression Scale and the Melancholia Scale, demonstrating that the patients treated with ECT plus imipramine in the acute phase showed greater symptom reduction than those treated with ECT plus paroxetine. However, in the post-ECT phase paroxetine was superior to both imipramine and placebo in preventing relapse. Thus in the post-ECT phase 65% of the placebo-treated patients relapsed, compared to 30% of the imipramine-treated patients and 10% of the paroxetine-treated patients. The psychometric analysis of the Melancholia Scale in the continuation or post-ECT phase showed that relapsing patients displayed a pattern with lack of interests, impaired concentration, depressed mood and anxiety among the less severe symptoms (first-compartment symptoms). In other words, these symptoms represent the gate to full-blown depression (second-compartment symptoms). Serotonin-selective antidepressants such as paroxetine appear I to be more effective in controlling the first-compartment symptoms.     

Combination treatment with clozapine and paroxetine in schizophrenia: safety and tolerability data from a prospective open clinical trial

Clozapine is a drug with many side effects, some of them with potentially hazardous outcome (e.g. seizures, agranulocytosis), if not carefully monitored. It has been shown that the metabolism of clozapine may be affected by concomitant treatment with selective serotonin reuptake inhibitors (SSRIs), while there have been reports of improved efficacy on negative symptomatology of clozapine in combination with SSRIs. Therefore, this prospective open clinical trial was performed to investigate the safety and tolerability of the coadministration of clozapine and paroxetine under control of serum concentrations of clozapine and its metabolites and the effect of this combination treatment on psychopathological outcome was evaluated. A total of 14 patients suffering from schizophrenia or schizodepressive disorder with predominant negative symptomatology were included. The duration of the study was at least 6 weeks for each patient. Initial treatment was a monotherapy with clozapine at a daily dose of 2.5 mg/kg weight. After two measurements of serum concentrations of clozapine and metabolites during steady state conditions, an add-on therapy with 20 mg paroxetine was initiated. No concomitant medication was allowed. The main finding of our prospective study was that addition of paroxetine to a monotherapy with clozapine was a well tolerated medication that did not give rise to new clinically relevant side effects. After addition of paroxetine the serum concentrations of clozapine and its major metabolites remained virtually constant. The results of the psychopathological measurements indicated a further clinical improvement, although the small open study could not test for efficacy.     

文拉法辛缓释剂与帕罗西汀治疗抑郁症对照研究

目的探讨文拉法辛缓释剂与帕罗西汀治疗抑郁症的临床疗效和安全性。方法将50例抑郁症患者随机分为两组各25例，研究组口服文拉法辛缓释剂治疗，对照组口服帕罗西汀治疗，观察6w。于治疗前及治疗第2w、4w、6w末采用汉密顿抑郁量表评定临床疗效，临床疗效总评量表-病情严重程度分量表评定疾病严重程度，副反应量表评定不良反应。结果两组治疗后汉密顿抑郁量表评分均较治疗前有显著下降（P〈0．01），且随着治疗时间的延续均呈持续性下降；研究组治疗第1w末较对照组下降更显著（P〈0．05），其他时点评分两组均无显著性差异（P〉0．05）。两组临床疗效总评量表-病情严重程度分量表治疗后评分均较治疗前有显著下降（P〈0．01），同期两组间比较均无显著性差异（P〉0．05）。两组不良反应均较轻微，多发生在治疗初期，并随着治疗的延续逐渐减轻或缓解。结论文拉法辛缓释剂与帕罗西汀治疗抑郁症效果均显著，安全性高、依从性好；但文拉法辛缓释剂起效更快，值得临床推广应用。     

Five-year comparison of antidepressant monotherapy

Objective. This study compares the effectiveness of several antidepressants in maintaining remission in unipolar depressed outpatients. Method. A retrospective chart review was performed on 2475 patients being seen in a rural private psychiatric practice. The study focused on those patients who had a clinical diagnosis of unipolar depression, and who achieved remission on antidepressant monotherapy. Data collected included patient demographics, Carroll Depression Rating Scale scores, and medication history. Results. A total of 346 patients (14%) met the inclusion criteria. Patients achieved remission in an average of 0.36 years and had an average of 0.28 relapses per year of treatment. Patients on escitalopram and sertraline had the shortest time until remission (0.24 and 0.27 years, respectively) but sertraline patients remained the longest in remission (62% after 5 years) and had the lowest percentage of treatment time spent in relapse (8%). Conclusions. Sertraline and to a lesser extent paroxetine were deemed superior to several other antidepressants in terms of maintaining remission and preventing relapse.