奥氮平合并氟西汀治疗非精神病性难治性抑郁症的研究

A study of olanzapine and fluoxetine combination therapy on nonpsychotic symptom,treatment-resistant depression

目的探讨抗抑郁药合并不同时间的非典型抗精神病药治疗非精神病性症状的难治性抑郁症的疗效、不良反应和卫生经济学价值。方法随机分为四组的患者中完成1年随访的有99例,分别为单用氟西汀组(27例)、合并奥氮平1～2月组(28例)、合并奥氮平4～6月组(29例),合并奥氮平12月组(15例)。对入组的四组患者分别评定HAMD、SDSS、体重、年收入等,在完成1年随访后再次评定HAMD、体重、TESS及1年内的收入、工作时间、复发数、治疗费用等。以HAMD总分减分数和痊愈率评定疗效、以TESS和体重评定不良反应,以工作时间、年收入、治疗费用等评定卫生经济学价值。结果四组均较疗前有不同程度的改善,合并奥氮平4～6月组和12月组较单用氟西汀组和合并1～2月组改善更明显。四组均未出现严重的不良反应,但合并各组的体重均较单用组有不同程度的增加。在年收入、工作时间和复发数上,合并奥氮平4～6月组和12月组要优于单用氟西汀组和合并1～2月组。合并4～6月组的治疗费用少于合并12月组。结论非典型抗精神病药奥氮平合并氟西汀治疗非精神病性症状的难治性抑郁症疗效肯定,不良反应少。而合并奥氮平的时间以4～6个月为佳。

Objective To observe the efficacy,side effect and health economics values of the therapy of antidepressants combining atypical antipsychotics with different administration lengths,on nonpsychotic symptom,treatment-resistant depression. Methods 99 patients out of the randomized 4 groups of patients completed one year follow-up study.The 4 groups are the group of single therapy of fluoxetine（27 patients）,the group of therapy of fluoxetine combining 12 months administration of olanzapine（28 patients）,the group of therapy of fluoxetine combining 46 months administration of olanzapine（29 patients） and the group of therapy of fluoxetine combining 12 months administration of olanzapine（15 patients）.At the starting point,measure of all patients in the four groups the HAMD,SDSS,weight and annual income ete at the end of 1 year follow-up study,measure of those patients the HAMD,weight.TESS and income of the past year,working hours,recurrent frequency and therapeutic sosts etc.The decreased scores of HAMD tests and the cure rates are used to evaluate the efficacy,the TESS scores and weight records are used to evaluate the side effect,and the working hours,annual income and therapeutic costs are used to evaluate the health economics values. Results All patients of the four groups improved at different degree comparing to their pre-therapeutic period.The group of therapy of fluoxetine combining 46 months administration of olanzapine and the group of therapy of fluoxetine combining 12 months administration of olanzapine were improved more significantly than the other two groups.No patients in the four groups showed severe side effects,but patients of the three groups of combination therapy had weight increase at different degree comparing with the fluoxetine single using group.In terms of annual income,working hours and recurrent frequency,the 46 months olanzapine combination group and the 12 months olanzapine combination group are superior to the other two groups.The 46 months olanzapine combination group is at lower therapeutic cost than the 12 months olanzapine combination group. Conclusions Therapy of olanzapine,the atypical antipsychotics,combining fluoxetine on nonpsychotic symptom,treatment-resistant depression has definite curative effect and less side effects.The most appropricate administration length of olanzapine in the combination is 46 months..