文拉法辛缓释剂和增效剂锂盐对选择性5-羟色胺再摄取抑制剂治疗无效抑郁症的治疗策略

Venlafaxine extended release and lithium salt for major depressive disorder in nonresponders to selective serotonin reuptake inhibitors

目的:分析文拉法辛缓释剂对选择性5-羟色胺再摄取抑制剂抗抑郁治疗无效的抑郁症的安全性和疗效。方法:从河南省精神病医院、湖南省精神病医院及中南大学精神卫生研究所2003-01/2005-06住院且对选择性5-羟色胺再摄取抑制剂抗抑郁治疗无效的抑郁症患者中,选择60例为观察对象。采用双盲对照研究的方法,随机分为2组,一组在原来的选择性5-羟色胺再摄取抑制剂类抗抑郁剂基础上合并锂盐治疗(加用锂盐对照组),一组改用文拉法辛缓释剂单一治疗(文拉法辛缓释剂单一治疗组),每组30例,分别在治疗后第2,4,6,8周末,由对患者不知情的主治医生采用汉密顿抑郁量表和临床总体印象量表进行疗效评定,其中,汉密顿抑郁量表是通过其减分率来评价疗效,汉密顿抑郁量表减分率=(治疗后汉密顿抑郁量表总分-治疗后汉密顿抑郁量表总分)/治疗后汉密顿抑郁量表总分×100%。采用As-berg抗抑郁剂副反应量表评定两组的药物副反应情况。结果:60例对选择性5-羟色胺再摄取抑制剂抗抑郁治疗无效的抑郁症均完成治疗,全部进入结果分析。①文拉法辛缓释剂单一治疗组治疗后第2,4,6,8周末的汉密顿抑郁量表的减分率与加用锂盐对照组接近,差异无显著性意义(P>0.05)。②文拉法辛缓释剂单一治疗组治疗后第2,4,6,8周末的临床总体印象量表的总体改善分值与加用锂盐对照组相似,差异无显著性意义(P>0.05)。③文拉法辛缓释剂单一治疗组在治疗后第6,8周末的Asberg抗抑郁剂副反应量表的总分显著低于加用锂盐对照组,差异有显著性意义[(4.12±2.72),(5.02±3.56),t=9.51,P<0.05];[(4.06±2.23),(4.77±2.81),t=8.77,P<0.05]。结论:对选择性5-羟色胺再摄取抑制剂类抗抑郁剂治疗无效的抑郁症加用锂盐和改用文拉法辛缓释剂治疗效果相当,但采用单一文拉法辛缓释剂治疗副反应较轻。文拉法辛缓释剂可以作为选择性5-羟色胺再摄取抑制剂类抗抑郁剂治疗无效的抑郁症有效和安全的治疗策略。

AIM： To analyze the therapeutic safety and effect of venlafaxine extended release （XR） monotherapy for major depressive disorder （MDD） in nonresponders to selective serotonln reuptake inhibitors （SSRIs）. METHODS： Sixty MDD inpatients, who were treatment-resistant to SSRIs, were selected from Mental Hospital of Henan Province, Mental Hospital of Hunan Province and Mental Health Institute of Central South University between January 2003 and June 2005. According to double blind and control method, all the subjects were randomly assigned to two groups： lithium salt augmentation group and venlafaxine XR monotherapy group, with 30 ones in each group. At the end of weeks 2, 4, 6, 8 after treatment, all the subjects were rated by the uninformed attending physicians with Hamilton Rating Scale for Depression （HAMD） and Clinical Global Impression （CGI） for evaluating the curative effect. Of the total, the curative effects were assessed with the score reduced rate of HAMD. Score reduced rate =（total score of HAMD before treatment-total score of HAMD after treatment）/total score of HAMD after treatment× 100%. Asberg Rating Scale for Side Effects （SERS） was used to assess the drug side effect of two groups. RESULTS： Totally 60 MDD patients who were resistant to SSRIs all completed the treatments and entered the result analysis. ①There was no significant difference in the score reduced ratio of HAMD and the score of total improvement of CGI between two groups at the 2^th, 4^th, 6^th and 8^th weekends of treatment （P 〉 0.05）.②Venlafaxine XR monotherapy had lower total scores of SERS than augmented treatment with lithium salt after 6 and 8 weeks of treatment, with significant difference [（4.12±2.72）, （5.02±3.56）, t=9.51, P 〈 0.05];[（4.06±2.23）, （4.77±2.81）, t=8.77, P 〈 0.05]. CONCLUSION： Venlafaxine XR monotherapy and lithium salt augmented treatment have similar curative effects for treatment-resistant to SSRIs. However, venlafaxine XR monotherapy possesses lighter side effects than lithium salt augmentation. So venlafaxine XR monotherapy is an efficacious and safe strategy for treating MDD resistant to SSRIs.