Use of antidepressants in the treatment of depression in Asia: Guidelines,clinical evidence,and experience revisited

Major depressive disorder is prevalent worldwide, and only about half of those affected will experience no further episodes or symptoms. Additionally, depressive symptoms can be challenging to identify, with many patients going undiagnosed despite a wide variety of available treatment options. Antidepressants are the cornerstone of depression treatment; however, a large number of factors must be considered in selecting the treatment best suited to the individual. To help support physicians in this process, international and national treatment guidelines have been developed. This review evaluates the current use of antidepressant treatment for major depressive disorder in six Asian countries (China, Korea, Malaysia, Philippines, Taiwan, and Thailand). No remarkable differences were noted between Asian and international treatment guidelines or among those from within Asia as these are adapted from western guidelines, although there were some local variations. Importantly, a shortage of evidence‐based information at a country level is the primary problem in developing guidelines appropriate for Asia, so most of the guidelines are consensus opinions derived from western research data utilized in western guidelines. Treatment guidelines need to evolve from being consensus based to evidence based when evidence is available, taking into consideration cost/effectiveness or cost/benefit with an evidence‐based approach that more accurately reflects clinical experience as well as the attributes of each antidepressant. In everyday practice, physicians must tailor their treatment to the patient's clinical needs while considering associated external factors; better tools are needed to help them reach the best possible prescribing decisions which are of maximum benefit to patients.     

阿戈美拉汀治疗老年卒中后抑郁的临床疗效比较

目的探讨阿戈美拉汀对比度洛西汀治疗老年卒中后抑郁症的临床疗效和不良反应。方法将90例诊断为脑卒中后抑郁的老年患者随机分为2组,研究组使用阿戈美拉汀,对照组使用度洛西汀,治疗12周,采用汉密尔顿抑郁量表(HAMD)和神经功能缺损量表(CSS)、睡眠障碍量表(SDRS)、副反应量表(TESS)评定疗效、功能恢复和不良反应。结果研究组和对照组治疗老年脑卒中后抑郁的HAMD、CSS、SDRS评分无显著性差异,总有效率分别为73.3%和71.1%,差异无统计学意义(P>0.05);TESS显示研究组阿戈美拉汀不良反应少,2组差异有统计学意义(P<0.05)。结论阿戈美拉汀有利于老年脑卒中后抑郁患者改善抑郁症状,促进神经功能康复,提高生活能力,是一种安全有效、不良反应少的抗老年卒中后抑郁药。     

度洛西汀治疗持续性躯体形式疼痛障碍的临床观察

目的:探讨度洛西汀对持续性躯体形式疼痛障碍(PSPD)的疗效、安全性及对生活质量的影响。方法:对85例PSPD患者予以度洛西汀60 mg/d,疗程8周。分别于治疗前、治疗2、4和8周时对患者进行疼痛视觉模拟量表(VAS)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、健康调查简表(SF-36)以及治疗过程中出现的症状量表(TESS)评分。结果:VAS和HAMA评分治疗后2周起、HAMD评分治疗后4周起较治疗前明显下降(P0.05或P0.01);疗程结束时对焦虑和抑郁的有效率分别是69.1%和65.4%,SF-36总分和躯体疼痛、一般健康状况、精力、情感职能、精神健康等因子分较治疗前显著提高(P0.05或P0.01);常见不良反应为食欲减退,恶心和疲乏。结论:度洛西汀治疗PSPD安全有效,并能改善患者生活质量。     

Recent status of the treatment of stress urinary incontinence

The therapeutic options for management of stress urinary incontinence can be conservative, pharmacological or surgical. The treatment of patients with stress urinary incontinence should be tailored to the individual to optimize care. A multitude of surgical techniques have emerged to treat this condition in recent years. The objective of the present review was to present an overview of current practice in the management of stress urinary incontinence while considering the evidence supporting the clinical effectiveness of these procedures.     

The Clinical Relevance of Pain Severity Changes: Is There Any Difference Between Asian and Caucasian Patients With Osteoarthritis Pain?

The objective of the present analysis was to determine whether changes in Brief Pain Inventory (BPI) average pain scores by patient global impression of improvement (PGI‐I) category and the cut‐off for clinically important difference (CID) were different between Asian and Caucasian patients with chronic pain due to osteoarthritis. This analysis used data from 3 (Caucasian) and 2 (Asian) randomized, placebo‐controlled, 10‐ to 14‐week duloxetine studies for the treatment of patients ≥40 years of age with osteoarthritis pain. The receiver operating characteristic (ROC) analysis was used to characterize the association between changes in BPI average pain scores and PGI‐I levels at study endpoint. The CID was characterized by PGI‐I, and the cut‐off point for CID in BPI average pain scores was determined by the intersection of a 45‐degree tangent line with each ROC curve. Data from 668 Asian and 868 Caucasian patients were available for analysis. Baseline BPI average pain ratings including worst and least pain were comparable between Asians and Caucasians. Ratings for percentage change from baseline to endpoint for BPI average pain scores in Asian patients and Caucasian patients were similar across the 7 PGI‐I categories, regardless of age, gender, study, and treatment. The ROC analysis results of cut‐off points in BPI average pain scores demonstrated the raw change cut‐off was ?3.0, and percentage change cut‐off was ?40% for both Asian and Caucasian patients. Overall, the present analysis concludes changes in BPI average pain scores by PGI‐I category and the cut‐off for CID were similar for Asian and Caucasian patients with chronic pain due to osteoarthritis.     

盆底肌锻炼联合度洛西汀治疗女性压力性尿失禁对照观察

目的：探讨盆底肌锻炼联合度洛西汀治疗女性压力性尿失禁的临床疗效和安全性。方法将80例女性压力性尿失禁患者随机分为两组,每组40例,均予以盆底肌锻炼治疗,研究组在此基础上联合度洛西汀治疗,观察8周。采用尿垫试验和尿失禁自我等级评价评定临床疗效。结果治疗8周末,研究组治愈率为86．8％、总有效率为100％,对照组分别为54．1％、70．3％,研究组显著高于对照组（ P＜0．01）;两组尿失禁量及尿失禁自我等级评价评分均较治疗前显著下降（P＜0．01）,研究组较对照组下降更显著（P＜0．01）。研究组偶见轻度头晕、头痛、口干等,且患者可耐受。结论盆底肌锻炼联合度洛西汀治疗女性压力性尿失禁疗效显著,优于单用盆底肌锻炼治疗,值得临床推广应用。     

度洛西汀与氟西汀治疗躯体形式障碍对照研究

目的：探讨度洛西汀与氟西汀治疗躯体形式障碍的临床疗效和安全性。方法将80例躯体形式障碍患者随机分为两组,研究组口服度洛西汀治疗,对照组口服氟西汀治疗,观察6周。于治疗前后采用临床疗效大体评定量表、症状自评量表的躯体化、焦虑、抑郁因子评定临床疗效,副反应量表评定不良反应。结果治疗6周末,研究组显效率69．2％、总有效率89．7％,对照组分别为44．4％、75．0％,研究组显效率显著高于对照组（χ2＝4．70,P＜0．05）,总有效率高于对照组,但差异无显著性（χ2＝2．84,P＞0．05）。治疗各时段副反应量表评分均显著低于对照组（P＜0．01）。结论度洛西汀与氟西汀治疗躯体形式障碍疗效均显著,但度洛西汀治疗起效更快、疗效更显著、安全性更高、依从性更好。     

Duloxetine-induced Syndrome of Inappropriate Secretion of Antidiuretic Hormone in a Super-elderly Patient

Duloxetine is widely used for pain control and depressive syndromes. One of its potential side effects is syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Duloxetine-induced SIADH causes hyponatremia, which leads to a variety of symptoms and has previously been reported in the elderly. In the present case, we experienced a case of the rapid onset of SIADH in a super-elderly woman receiving low-dose duloxetine. Elderly patients tend to have lower duloxetine doses and an earlier onset than non-elderly patients. When hyponatremia occurs after duloxetine administration, duloxetine-induced SIADH should be considered, especially in high-risk elderly patients, regardless of the duloxetine dose or duration of treatment.     

度洛西汀肠溶胶囊治疗抑郁症的多中心随机双盲对照临床研究

目的评价度洛西汀肠溶胶囊治疗抑郁症的疗效和安全性。方法采用随机、双盲、双模拟、氟西汀平行对照、剂量固定的多中心研究。受试者分别口服度洛西汀肠溶胶囊60 mg·d~(-1)或氟西汀胶囊20 mg·d~(-1),共观察6 wk。结果意向性分析集(ITT)抑郁症病人238例,其中度洛西汀组(试验组)117例和氟西汀组(对照组)121例。符合方案集(PP)病人228例,其中试验组111例,对照组117例。根据PP样本,治疗6 wk后,试验组和对照组汉密尔顿焦虑量表(HAMD)17项总分减分值分别为(15±s 5)分及(16±6)分,与基线相比均存在非常显著差异(P<0.01),但组间无显著差异(P>0.05);试验组和对照组的有效率分别为89.2%和88.0%,2组相比差异无显著意义(P>0.05)。试验组总不良反应发生率为35.0%,对照组为24.8%,2组相比差异无显著意义(P>0.05)。结论度洛西汀肠溶胶囊治疗抑郁症的疗效、安全性以及治疗抑郁症伴焦虑的疗效均与氟西汀相似,是一种安全有效的抗抑郁药。