不同SSRIs对首发抑郁症患者疗效及社会功能改善作用比较

Comparisons of SSRIs on the therapeutic effect and improvement of social function in first-episode depression

目的评价不同5-羟色胺再摄取抑制剂类药物(SSRIs)对首发抑郁症患者疗效及社会功能的改善作用。方法对符合要求的首发抑郁症患者103例,按照抑郁症防治指南规范化治疗流程,随机给予西酞普兰、帕罗西汀、氟西汀、舍曲林四种不同SSRIs类药物,分别在治疗前及治疗第2、6、12周末采用汉密尔顿抑郁量表(HAMD-17)评价疗效,并采用工作和社会适应量表(WSAS)评价患者社会功能改善情况。结果共有64例患者完成整个研究,其中53例患者达到临床治愈标准。各组间不同时间HAMD得分没有显著差异,但是均低于治疗前;各组随药物作用时间的延长,WSAS得分逐渐减少,而且与治疗前存在显著差异(均P<0.01);治疗2周末,舍曲林组WSAS评分最少,而且与西酞普兰组和帕罗西汀组存在显著差异(P<0.05)。结论在临床规范化治疗模式下,不同抗抑郁药物对首发抑郁症患者治疗疗效和社会功能的改善作用无显著差异,但是舍曲林在早期治疗中,更适合社会功能低下的患者。

Objective To investigate the effect of different SSRIs on the therapy and improvement of social function in first-episode depression. Methods A total of 103 consenting adult outpatients with confirmed DSM-IV diagnosis of depressive disorder were involved in a randomized, single-blinded, parallel-controlled trial. All patients were given at least 12-week treatment with citalopram, or paroxetine, or fluoxetine and or sertraline according with the standard treatment program of guideline for management of depression. The therapeutic efficacy was measured with the Hamilton Depression Scale （HAMD）, and the improvement of social function was measured with Work and Social Adjustment Scales （WSAS） at the baseline and at the 2nd, 6th, 12th weekend of the treatment. Results 64 patients completed the trial and 53 cases were clinical cured. Score of HAMD of each group decreased significantly when compared with the baseline but showed no significant differences among the 4 groups at each interviewpoint. Score of WSAS in each group decreased gradually with the prolong of the treatment, and showed significant differences when compared with the baseline （P 〈0.01）. At the 2nd weekend of the treatment, score of WSAS in sertraline group was at the lowest point and showed significant differences when compared with that of citalopram group or paroxetine group （ P 〈 0.05 ）. Conclusion These four SSRIs have similar effect on therapeutic efficacy and improvement of social function in patients with first - episode depression in the mode of standard treatment program. Sertraline maybe more suitable for depressive patients with social hypofunction in early treatment.