4种SSRI类抗抑郁药物治疗卒中后抑郁的疗效及对生活质量的影响

Comparisons of effect of four different SSRIs on post-- stroke depression

目的观察4种常用的SSRI类抗抑郁药物治疗卒中后抑郁（PsD）的疗效，以及对患者社会功能、生活质量的影响。方法117例卒中后抑郁的住院患者被随机分为4组，分别给予西酞普兰、艾司西酞普兰、舍曲林、帕罗西汀4种抗抑郁药物治疗，于治疗开始后2，4，8周时分别使用汉密尔顿抑郁量表（HAMD-17）、汉密尔顿焦虑量表（HAMA）、日常生活能力评估量表（ADL）、生活质量与满意程度量表（Q—LEs—Q—SF）等进行疗效、功能、生活质量等方面的评估。结果随着治疗时间的延长，各组HAMD分数呈下降趋势，而且组内各时间点的评分之间差异均有统计学意义（P均〈O．05）；在治疗2周末时，帕罗西汀组HAMD评分与其他3组差异有统计学意义（P〈0．05）；在访视结束时各组间有效率差异无统计学意义（P〉0．05）。治疗前HAMD、HAMA评分与Q—LES—Q—SF评分呈负相关（P〈0．01），访视结束时亦呈负相关（P〈0．01）；治疗前HAMA评分与ADL呈正相关（P〈0．01），访视结束时HAMD、HAMA评分与ADI。均呈正相关（P〈0．01）。结论PSD患者抑郁、焦虑程度与日常生活功能呈负相关、与生活质量呈负相关；4种抗抑郁药物治疗PSD患者在治疗8周末时疗效无明显差异，但帕罗西汀起效更快。

Objective To evaluate the efficacy of 4 kinds of SSRIs in the treatment of post--stroke depression and their effects on quality of life. Methods Totals of 117 patients with post--stoke depres- sion were enrolled into a randomized controlled trial and were randomly assigned to four groups： citalo- pram, escitalopram, sertraline and paroxetine. All patients were given at least one 8--week treatment with one of the four study drugs. The measure scales, including Hamilton depression scale （HAMD-- 17）, Hamilton Anxiety Scale （HAMA）, Activity of Daily Living Scale （ADL）, Quality of life and life satisfaction questionnaire--short form （Q--LES--Q--SF） were given at before and after treated 2,4,8 weeks. Results HAMD and HAMA scores declined within each group, with statistical significance （P〈 0.05） ; HAMD, HAMA score of the paroxetlne group scores were different （P 〈 0.05） from the other three groups after 2 weeks treatment. Antidepressant efficacy of the four drugs showed no difference （X2 =1.17,P 〉 0.05）. HAMD, HAMA scores and the Q--LES--Q--SF scores were negatively correlated before and after the study （P 〈 0.01）. Before the study, HAMA and ADL were positively correlated （P 〈0.01）, and at the end, HAMD, HAMA, and ADL were positively related （P 〈 0.01）. Conclusions Severity of depression showed a negative correlation with physical function and quality of life of the post--stroke depression patients. The four antidepressants have a similar efficacy in 8 week treatment, but paroxetine showed a faster onset of effect. There were no severe adverse effects observed in any of the four groups.