米氮平与阿米替林治疗抑郁症并发慢性疼痛的对照研究

Comparing Study of Mirtazapine and Amitriptyline on Treating Depression with Chronic Pain

目的比较米氮平与阿米替林治疗抑郁并发慢性疼痛的效果和不良反应。方法68例同时符合抑郁症及慢性疼痛诊断标准的门诊患者随机分为治疗组36例，对照组32例。患者使用阿普唑仑，剂量控制在0．2～0．8mg·d^-1。治疗组加用米氮平，第1天15mg，第4天30mg，第7天如有必要可增加到45mg，均为晚餐后1次顿服。对照组加用阿米替林，第1天50mg，第4天100mg，第7天150mg，分中、晚餐后2次口服。入组前及治疗后的第7，14,28天分别对患者进行汉密尔顿抑郁量表（HAMD）评分、汉密尔顿焦虑量表（HAMA）评分、不良反应量表（TESS）评分、视觉模拟评分（VAS）评定。结果入组时两组患者HAMD、HAMA、VAS评分差异无显著性（P〉0．05）。治疗第7天，治疗组的HAMD、HAMA、VAS评分迅速下降，与入组时比较差异有极显著性（P〈0．01），并显著或极显著低于对照组（P〈0．05或P〈0．01）。治疗第28天两组HAMD、HAMA、VAS评分与入组时比较差异有极显著性（P〈0．01）。但两组间HAMD、HAMA、VAS评分比较差异无显著性（P〉0．05）。两组患者有效率差异无显著性（P〉0．05）。治疗组TESS总分均显著或极显著低于对照组（P〈0．05或P〈0．01）。结论米氮平治疗抑郁并发慢性疼痛患者，能迅速控制抑郁和焦虑症状，且能有效地改善或者消除疼痛症状，并且不良反应相对较轻。

Objective To compare the efficiency and side effects of mirtazapine and amitriptyline on treating depression accompanied with chronic pain. Methods 68 out-patients consistent with the diagnostic criteria of depression and chronic pain simultaneously were divided into the treatment group with 36 and control group with 32. Patients were treated with amitriptyline at the range of 0.2 -0.8 mg·d^-1. The treatment group was added with mirtazapine 15 mg, 30 mg,or to 45 mg if necessary, respectively once in the supper. The control group was added with amitriptyline 50,100 and 150 mg at the first, fourth and seventh day, respectively, during lunch and supper. HAMD, HAMA,TESS, VAS were assessed before treating and 7, 14, 28 days after treating. Results No significant difference of HAMD, HAMA, VAS existed between two groups before treatinent. After 7 days＇treatment, the score of HAMD,HAMA,VAS in the treating group decreased rapidly, the significant difference was found（ P 〈 0.01 ） compared with those before treating（ P 〈 0.01 ）. And the score was obviously lower than the control group（ P 〈 0.05 ,P 〈0.01 ）. After treating for 28 days, scores of HAMD,HAMA,VAS of both groups were significantly different from those before treatment（P 〈 0.01 ）. But scores of HAMD, HAMA, VAS between two groups showed no difference （P 〉 0.05 ）. The difference of efficiency between two groups was not obvious （ P 〉 0.05 ）. The total score of TESS in the treatment group was different or significantly different from that in the control group （ P 〈 0.05, P 〈 0.01 ）. Conclusion Mirtazapine could treat depression accompanied with chronic pain. It not only relieves the symptoms of depression and anxiety, but also improves or eliminates the symptoms of pain with relatively mild side effects.