氟西汀合用小剂量奥氮平治疗重度抑郁症的随机对照试验

The randomized placebo-controlled trial on fluoxetine combined with olanzapine in treating major depression

目的 了解奥氮平合用氟西汀治疗重度抑郁症的疗法及起效时间。方法 5 3例符合CCMD 3抑郁症诊断标准且临床判断属于重度抑郁症(HAMD评分≥2 8分)患者,随机分成2组。阿普唑仑组:阿普唑仑合用氟西汀,阿普唑仑0 4mg中午及睡前合用氟西汀2 0mg 1/早;奥氮平组:奥氮平合用氟西汀,奥氮平2 5mg 1/晚合用氟西汀2 0mg 1/早;疗程6周,分别于治疗前及治疗后1、2、4、6周末进行汉密顿抑郁量表(HAMD)和汉密顿焦虑量表(HAMA)评定,用减分率来确定起效时间,并观察HAMD量表中睡眠因子及躯体化因子在治疗前后各时段的改善情况。结果 奥氮平合用氟西汀组于治疗后1周显效(显效率67% ) ,奥氮平组各观察时段HAMD及HAMA的评分较阿普唑仑组明显低,睡眠及躯体化障碍各观察时段明显改善。结论 氟西汀合用奥氮平是治疗重度抑郁症快速有效的方法。

Objective To evaluate the efficacy and effective time of low dosage of olanzapine combined with fluoxetine in treatment of major depression. Methods A total of 53 patients who suffered from major depression diagnosed according to CCMD-3 and the score of Hamilton rating scale for depression (HAMD) over 28, were randomly divided into 2 groups: alprazolam group (0.4 mg alprazolam, 2/d and 20 mg fluoxetine, 1/d), olanzapine group (2.5 mg olanzapine, 1/d, and 20 mg fluoxetine, 1/d). The treatment period lasted six weeks and the subjects were evaluated by using HAMD and HAMA at week 1, 2, 4, 6. The effective time was estimated by decreasing rate of the scale of HAMD and the amelioration of sleep disturbance and anxiety/somatization in HAMD were observed before and during the treatment. Results The therapeutic effects in olanzapine group at week 1 were observed with the apparent rate of 67%. The scores of HAMD and HAMA in olanzapine group were obviously lower than those in alprazolam group at each time point. The sleep disturbance and anxiety/somatization of the patients in olanzapine group improved significantly as compared with those in alprazolam group. Conclusion Fluoxetine combined with olanzapine is a fast and effective method to treat major depression.