奥氮平联合氟西汀治疗双相抑郁的对照研究

A controlled study of olanzapine associated with fluoxetine and paroxetine associated with lithium carboate in the treatment of bipolar depression

目的探讨奥氮平联合氟西汀治疗双相抑郁的疗效及安全性。方法将符合CCMD-3中国精神障碍分类和诊断标准(第三版)的60例双相障碍抑郁患者随机分为两组,每组30例。研究组用奥氮平联合氟西汀,对照组用帕罗西汀联合碳酸锂,分别治疗8周。以汉密尔顿抑郁量表(HAMD),汉密尔顿焦虑量表(HA-MA),治疗时出现的症状量表(TESS)在治疗前和治疗后第2、8周末评价疗效和安全性,在第2、8周末及4、4、需要时用Bech-Rafaelse躁狂量表(BRMS)评定转躁情况。结果两组治疗后HAMD、HAMA评分均较治疗前显著降低(P<0.01),研究组和对照组显效率分别为66.67%和64.29%,无显著性差异(P>0.05)。研究组不良反应为嗜睡、头昏和昏厥、便秘、鼻塞、体重增加等。对照组则为兴奋或激越、肝功能异常、震颤、恶心呕吐、食欲减退或厌食、头痛等,两组差异有显著性(P<0.05)。结论奥氮平联合氟西汀可有效治疗双相抑郁,不良反应较少,依从性好,并能减少诱发躁狂的风险。

Objective To explore the efficacy and safety of olanzapine associated with fluoxetine in the treatment of bipolar depression. Methods Patients who met CCMD -3 criteria for bipolar depression were randomized into two groups：olanzapine as- sociated with fluoxetine group（ n = 30）and paroxetine associated with lithium carboate group （n = 30）in control study. The treat- ment duration was 8 weeks. All patients were evaluated with HAMD, HAMA and TESS before treatment and at the end of the sec- ond ,fourth and eighth week of treatment, and BRMS before treatment at the end of the second, fourth and eighth week of treatment. Results The research group and the contrast group have significant gender difference about HAMD, HAMA of before treatment and at the end of the second eighth week（ P 〈 0. 01 ）. The research group for the efficient 66.67%, major side effect of a sleepiness dizziness constipation nasal congestion and weight gain; The contrast group for the efficient 64.29%, major side effect of excited liver damage tremor nausea and vomiting loss of appetite and headache. The two group of are the efficient are no significant gender difference（ P 〉 0. 05 ） and the side effect have significant gender difference（ P 〈 0. 01 ）. Conclusion The effect of olanzapine asso- ciated with fluoxetine in the treatment of bipolar depression ,wlht less side effects and good adherence. And can reduce the induced manic.