非典型抗精神病药对难治性抑郁症的治疗作用

Therapeutic effect of atypical antipsychotics on treatment-refractory depression

目的:探讨非典型抗精神病药合并抗抑郁药治疗不伴精神病性症状的难治性抑郁症的疗效和不良反应。方法:将75例患者随机平分为利培酮组(25例),奥氮平组(25例),奎硫平组(25例),均合并使用同样剂量的氟西汀。疗程8周。采用汉密尔顿抑郁量表(HAMD)、社会功能缺陷筛选量表(SDSS),在治疗前及治疗1、2、4、8周各测定1次;并在治疗前及治疗8周测血常规、肝功能、体质量及治疗中出现的症状量表(TESS)、锥体外系反应量表(RSESE)。以HAMD减分率评定疗效,比较3组的不良反应。结果:利培酮组、奥氮平组和奎硫平组的显效率分别为44%、88%、76%,奥氮平组和奎硫平组的疗效要好于利培酮组。均未出现严重的不良反应,奎硫平组不良反应最小。结论:非典型抗精神病药合并氟西汀治疗不伴精神病性症状的难治性抑郁症疗效好,起效较快,安全,不良反应少。

Objective：To explore the efficacy and side effect of atypical antipsychotics combining antidepressants treating treatment-refractory, nonpsychotic depression. Method： The patients attending the study （ n = 75） were randomized to three groups： rispefidone（ n = 25）, olanzapine（ n = 25） or seroquel（ n = 25） ,and every group was combined with the same dose of fluoxetine for eight weeks. Hamilton depressive scale （HAMD）, social disability screening schedule （SDSS）,were tested before treatment and after 1,2,4 and 8 weeks. Blood routine, hepatic function, body weight,treatment emergent symptom scale （TESS） and rating scale for extrapyramidal side effects （RSESE） were examined before and after treatment. Evaluate the efficacy with the decrease rate of HAMD scores and compared all side effects among 3 groups. Results： The response rates of risperidone group 44%, olanzapine group 88%, and seroquel group 76%, olanzapine group and seroquel group demonstrated higher efficacy than risperidone group. No serious side effects were seen in these three groups,and seroquel group showed the least adverse reaction among all three groups. Conclusion： Antipsyehoties combining antidepressants fluoxetine are demonstrated efficacy, fast onset of action, safe and few side effects in treating patients with treatment-resistant, non-psychotic depression.