米氮平与舍曲林治疗老年抑郁症对照研究

A control study of mirtazapine vs. sertraline in the treatment of senile depression

目的探讨米氮平与舍曲林治疗老年抑郁症的临床疗效及安全性。方法将70例老年抑郁症患者随机分为研究34例和对照组36例，研究组口服米氮平治疗，对照组口服舍曲林治疗，观察6w。于治疗前及治疗第1w、2w、4w、6w末采用汉密顿抑郁量表评定临床疗效，副反应量表评定不良反应。结果治疗6w末，研究组显效率79．41％，总有效率94．12％；对照组分别为69．44％，91．67％（P〉O．05）。两组治疗1w末起汉密顿抑郁量表总分均较治疗前有显著下降（P〈0．05），减分率呈持续性升高；研究组治疗1w末汉密顿抑郁量表总分较对照组下降更显著（P〈0．01），减分率显著高于对照组（P〈0．05）。两组不良反应多出现在治疗初期，研究组主要表现为嗜睡、头昏、食欲增加和体重增加等，对心电图几乎无影响；对照组主要表现为兴奋、激越、胃肠道反应、性功能障碍等。治疗各期研究组副反应量表总分显著低于对照组（P〈0．05或0．01）。结论米氮平治疗老年抑郁症疗效与舍曲林相当，但米氮平起效更快，安全性更高。

Objective To explore the clinical efficacy and safety of mirtazapine vs. sertraline in the treatment of senile depression . Methods Seventy senile depression patients were randomly divided into research group（n=34） took orally mirtazapine and control group（n=36） did sertraline for 6 weeks. Before treatment and at the ends of the 1st ,2nd ,4th and 6th week treatment, clinical efficacies were assessed with the Hamilton Depression Scale （HAMD） and adverse rehctions with the Treatment Emergent Symptom Scale（TESS）. Results At the end of the 6th week, obvious and total effective rates were 79.41% and 94.12% in the research and 69.44% and 91.67% in the control group,respectively, （P〉0.05）. Since the end of the 1st week,the HAMD total scores of both groups lowered more significantly compared with pretreatment（P〈0. 05） and did eontinously along with the time of therapy lasting, score-decrement rate heightened eontinously;at the end of the 1st week, the HAMD total score lowered more significantly（P〈 0.01） and score-decrement rate was significantly higher（P〈0.05） in the research than in the control group. Adverse reactions of both groups appeared more in the initial stage of treatment, those of the research were mainly lethargy, dizziness, increased food appetite, weight gain and so on, and had no effects on ECG; those of the control were mainly excitement, agitation, gastrointestinal tract reactions, sexual dysfunction and so on. After treatment, the total score of the TESS was significantly lower in the research than in the control group（P〈0.05 or 0.01）. Conclusion Mirtazapine has an evident effect equivalent to sertraline in treating senile depression,but the former takes effect more quickly, has higher safety.