艾司西酞普兰与阿米替林对抑郁自杀相关症状的临床对照研究

Clinical comparison on the effects of escitalopram and amitriptyline in treating depression patients with suicide-related symptoms

目的 与阿米替林对照,探讨艾司西酞普兰对抑郁症自杀相关症状的疗效和安全性.方法 伴自杀相关症状的抑郁症随机分组,研究组35例予艾司西酞普兰10～20 mg/d治疗,对照组33例以阿米替林75～250mg/d治疗,均辅以心理治疗,观察8周.于治疗前和治疗1,2,4,6,8周末评定汉密顿抑郁量表（HAMD-17）、临床疗效总评量表（CGI-SI）和调查自杀相关症状,4周末以副反应量表（TESS）评估安全性.结果 治疗前研究组想死（97.1％）、尝试自杀（91.4％）、自杀观念（88.6％）、自杀计划（80.0％）、绝望（71.4％）、自杀行为（54.3％）等症状检出率与对照组相近（分别为97.0％、97.0％、90.9％、87.9％、72.7％、54.5％,x2=0.00～0.94,P＞0.05）;两组检出率治疗后比治疗前显著下降（P＜0.01）.1周末研究组绝望（37.1％）、自杀计划（45.7％）和自杀观念的检出率（48.6％）已显著低于对照组（相应为63.6％、72.7％ 、75.8％,x2=4.77、5.12、5.32,均P＜0.05）.4周末研究组不良反应总发生率（11.4％）显著低于对照组（62.9％,x2=21.95,P＜0.01）.结论 艾司西酞普兰对抑郁症自杀相关症状的疗效与阿米替林相当,但起效更快、安全性更高.

Objective To explore the effects and safety of escitalopram on suicide-related symptoms for depression patients controlled with amitriptyline.Methods Depression patients with suicide-related symptoms were randomly grouped.The study group（n=35） were treated with escitalopram 10 mg/d to 20 mg/d and the control group（n=33） were done with amitriptyline 75 mg to 250 mg daily.Both groups with psychotherapy were carried out for 8 weeks＇ observation.The Hamilton Depression Rating Scale （HAMD-17） and Clinical Global Impression-severity of illness （CGI-SI） were tested and suicide-related examined before and after 1,2,4,6 and 8 weeks＇treatment.The Treatment Emergent Symptom Scale （TESS） was checked at 4th week to evaluate safety.Results In the study group,the incidence of wishing to die （97.1%）,suicidal attempts （91.4%）,suicidal ideations （88.6%）,suicidal plans （80.0%）,hopelessness （71.4%） and suicidal behavior （54.3%） was similar to the control group（97.0%,97.0%,90.9%,87.9%,72.7% and 54.5%,respectively,x2 =0.00-0.94,P〉0.05）.The incidence of suicide-related symptoms showed significantly lower after treatment than before （P〈0.01）.At 1st week treatment,the incidences of hopelessness （37.1%）,suicidal plans （45.7%） and suicidal ideations （48.6%）showed significantly lower in the study group than those in the control group（63.6%,72.7% and 75.8%,respectively,x2 =4.77,5.12,5.32,P〈 0.05）.The study group showed significantly lower side-effects （11.4%） at 4th weeks＇ treatment than the control group（62.9%,x2 =21.95,P〈0.01）.Conclusion The effects of escitalopram on suicide-related symptoms for depression patients is similar to amitriptyline but with faster effect and higher safety.