维生素B_(12)对抑郁症的辅助治疗

Vitamin B_(12) as Adjunctive Therapy in Patients with Major Depressive Disorder

目的观察抑郁症患者血清维生素B12水平,探讨抗抑郁剂合并维生素B12治疗维生素B12缺乏抑郁症的疗效及安全性。方法对400名抑郁症患者进行血清维生素B12浓度测查,将筛查出的维生素B12缺乏的抑郁症患者70例,随机分为两组,各35例。对照组根据病情口服西酞普兰20～40 mg/次,每日1次,治疗8周;研究组根据病情口服西酞普兰20～40 mg/次,每日1次,同时合并使用维生素B12,治疗8周。研究组及对照组治疗前后1,2,4,8周末分别进行汉密尔顿抑郁量表（HAMD）评定;治疗后1,2,4,8周末分别评定副反应量表（TESS）;治疗前及治疗后4,8周末分别查血清维生素B12浓度。结果抑郁症患者血清维生素B12平均水平（359.7±183.2）pg/ml,维生素B12缺乏发生率为19.5%,研究组与对照组第1周末汉密尔顿抑郁量表评分差异无显著性（P＞0.05）,治疗第2,4、8周末有显著性差异（P〈0.01）,研究组有效率为94.3%,对照组为74.3%,两组差异有显著性（P〈0.01）,血清维生素B12浓度治疗后4,8周末有显著性差异（P〈0.01）,且研究组汉密尔顿抑郁量表评分与血清维生素B12浓度负相关。两组不良反应均较轻微,TESS评分比较差异无显著性（P＞0.05）。结论抑郁症患者血清维生素B12平均水平较正常明显降低,维生素B12缺乏发生率高,维生素B12辅助抗抑郁剂治疗可明显提高疗效,且不增加不良反应。

Objective To observe serum vitamin B12 levels in patients with depression and explore the curative effects and safety of antidepressant combined with vitamine B12 in the treatment of depression with vitamin B12 deficiency. Methods Serum vitamin B12 levels in 400 patients with major depressive disorder were determined at baseline. 70 depressive patients with vitamin Bt2 deficiency were randomly divided into research group（ n = 35, citalopram 20 - 40mg/d combined with Vitamin B12 ） and control group （ n = 35, single 20 40mg/d） for 8weeks;Clinical effects and adverse reactions were assessed with the Hamilton Depression Scale（HAMD） and Treatment E- mergent Symptom Scale （TESS）, respectively. Results Serum vitamin BI2 average levels in patients with depression was （359.7 ＋_ 183. 2） pg/ml. The occurrence of low serum vitamin levels was 19.5%. There were no significant differences on the scores of HAMD between the two groups at the 1 weekend（P 〉 0.05 ）. There were significant differences on the scores of HAMD between the two groups at the 2, 4 and 8 weekend（ P 〈 0.01 ）. Curative effects of research group was higher in research group than in control group （94.3 % vs 74.3 % , P 〈0.01 ）. The vitamin B12 level was negatively related with HAMD score in research group. Adverse reactions were mild in both groups （ P 〉 0.05 ）. Conclusion Serum vitamin B12 levels in patients with depression is lower and antidepressant combined with vitamine Bi2 is a useful and safety method in the treatment of depression with vitamin 812 deficiency.