国产西酞普兰联用多塞平治疗广泛性焦虑障碍的开放性研究

目的：通过国产西酞普兰和多塞平低剂量联用的开放性治疗,探讨其对广泛性焦虑障碍（GAD）的效果及安全性。方法：以西酞普兰20mg/d原服有选择性5-羟色胺（5-HT）再回收抑制剂者药物及剂量保持不变]加用多塞平（75-125mg/d）,并与同期志愿接受文拉法辛治疗者对照比较。选择Hamilton焦虑量表（HAMA）评定治疗前,治疗后1、2、4、6周分值变化,以基线减分率评定6周治疗效果,副反应量表（TESS）评定治疗过程中的不良反应发生率。结果：两组完成6周治疗者50例和30例,脱落率分别为10.7%和9.1%,P=0.70,6周基线减分率差异均无统计学意义;有效率分别为92.0%、93.3%,P=0.83,两法效果差异经Ridit值比较也无统计学意义。HA-MA评定中,精神性焦虑因子减分差值在4-6周时有重要统计学意义。靶症状结合因子减分差值分析中,联用组的失眠、记忆/注意障碍和呼吸系统症状在4-6周时较文拉法辛组改善更为明显（P〈0.05-0.01）。不良反应中按SS集分析,联用组有较高的口干、便秘及体重增加现象。结论：西酞普兰等选择性5-HT再回收抑制类药物与抑制NE再摄取作用的多塞平联用对GAD显示出与SNRIS相同的效果,且安全性较高。因治疗成本不足文拉法辛的1/3,对低收入病员群体是一种更为实际的治疗方法。

Open study of citalopram combined with doxepin in treating generalized anxiety disorder

AIM： To explore the clinical efficacy and safety of citalopram combined with doxepin in the treatment of generalized anxiety disorder （GAD）. METHODS： The combination group was treated with citalopram （20 mg/d） and doxepin（75 - 125 mg/d）,as the same period the other group was treated with venlafaxine, then the scores before and after 1,2, 4, 6 weeks treatment were assessed by Hamilton Anxiety Scale （HAMA）, the clinical efficacy after 6 weeks treatment using baseline reducing rate was assessed, and the adverse reaction incidence was assessed by using the TESS. RESULTS： After 6 weeks, 50 patients completed the treatment in combination group, and 30 patients completed the treatment in venlafaxine group. The expulsion rates were 10.7% and 9.1% respectively, P = 0.70. The baseline reducing rate did not show any significant difference, the efficient rates were 92.0% and 93.3%, P = 0.83. The effect of two methods had no significant difference through the Ridit value comparison. The psychosis anxiety factors showed conspicuous and most conspicuous difference during 4 -6 weeks through HAM. The target symptoms factors were analyzed, the symptoms of insomnia, dysmnesia/ attention dysfunction and respiratory system of combination group were much improved（ P 〈 0.05 or 0.01 ） compared with the venlafaxine group. The adverse reaction was analyzed by SS collection, it showed the patients in combination group had more dry mouths, constipation and weight gain. CONCLUSION： Citalopra combined with doxepin showed the same clinical efficacy as the SNRIs and more safety, during the treatment of GAD, the treating cost would be less than 1/3 of the venlafaxine. It was a more practical way in treatment for the patients with lower income.