度洛西汀、米氮平、帕罗西汀与阿米替林治疗伴躯体症状抑郁症的对照研究

目的探讨度洛西汀、米氮平、帕罗西汀与阿米替林治疗伴躯体症状抑郁症的疗效和安全性。方法将符合国际疾病分类第10版（ICD一10）诊断标准的伴躯体症状的抑郁症患者117例，随机分为4组，分别给予度洛西汀、米氮平、帕罗西汀与阿米替林治疗，疗程8周。采用汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）和副反应量表（TESS）评定疗效及不良反应。结果4组药物均能迅速起效，第2周末HAMD、HAMA评分较治疗前差异有统计学意义（P〈0．05），治疗8周后，4组闯疗效无统计学意义（P〉0．05），4组HAMD、HAMA评分较治疗前有统计学意义（P〈0．01），4个治疗组不良反应有统计学意义（P．〈0．01）。结论治疗伴躯体症状的抑郁症，四药总体疗效相似，均起效较快，度洛西汀、米氮平和帕罗西汀不良反应相对少，依从性好。提示四种药物均为治疗伴躯体症状的抑郁症一线药物，度洛西汀、米氮平和帕罗西汀值得临床推广。

Comparative study on Duloxetine, Mirtazapine, Paroxetine and Amitriptyline in treatment of major depression with somatic symptoms

Objective To explore the curative efficacy and the safety of Duloxetine, Mirtazapine, Paroxetine and Amitriptyline in the treatment of the major depression with somatic symptoms. Methods 117 patients with depression under the ICD--10 treatment criterion were randomly divided into four groups and treated by Duloxetine, Mirtazapine, Paroxetine and Amitriptyline respectively for 8 weeks. The efficacy and side effects were assessed by HAMD, HANA and TESS. Results Four groups of medicines act fast. At the end of the second week, the marks of HAMD and HAMA in the treatment groups of Duloxetine and Mirtazapine showed greatly significant difference （P 〈 0.01）, and so did in the groups of Paroxetine and Amitriptyline （P 〈0. 05）. 8 weeks after treatment, there was no significant difference in the curative efficacy among four groups （P 〉 0.05）. However, the marks of the HAMD and HAMA showed more significant difference than that before treatment （P 〈0.01）. The side effects in the four groups also showed a significant difference （P 〈 0.01）. Conclusions Regarding to the treatment of depression with somatic symptoms, the overall effect is similar among four medicines examined, all act fast, and Duloxetine, Mirtazapine and Paroxetine were compliant with fewer side effects. Pay attention to that the four medicines were very practical in treating the depression with somatic symptoms. Duloxetine, Mirtazapine and Paroxetine, in particular, are worth to use further.