米氮平治疗老年抑郁症效果及其对血清脑源性神经营养因子的影响

Effect on efficacy and BDNF of Mirtazapine in elderly patients with major depression

目的 探讨米氮平治疗老年抑郁症的临床效果和安全性及其对血清脑源性神经营养因子（BDNF）的影响。方法2011年12月～2013年10月就诊于南京医科大学附属精神卫生中心,符合《中国精神疾病分类方案与诊断标准》第3版（CCMD-3）抑郁症诊断标准的老年抑郁症患者62例,进行为期8周的开放性米氮平治疗,以汉密尔顿抑郁量表（HAMD）和临床疗效总评量表（CGI）为评估临床疗效的工具。在入组时和8周的开放性治疗结束时检测BDNF。结果 完成研究的老年抑郁症患者58例,所用米氮平的平均剂量为（31.3±7.8）mg/d。米氮平治疗8周后HAMD总分、病情严重程度、疗效总评和疗效指数与治疗前相比明显下降,差异有高度统计学意义（P〈0.01）;治疗后体重稍有增加,但差异无统计学意义（P〉0.05）;BDNF较治疗前明显升高,差异有高度统计学意义（P〈0.01）。副作用主要为过度镇静、入睡时下肢不适、头晕、腹泻。结论 米氮平治疗老年抑郁症安全、有效,能提高BDNF水平。

Objective To investigate the clinical efficacy and safety of Mirtazapine in treatment of elderly depression and impact on serum brain-derived neurotrophic factor （BDNF）. Methods From December 2011 to October 2013 for treatment at Wuxi Mental Health Center Affiliated to Nanjing Medical University, 62 elders who met diagnostic criteria for major depression in Chinese Classification of Mental Disorders （CCMD-3） were treated with Mirtazapine for 8 weeks, Hamilton depression scale （HAMD） and clinical global impression （CGI） were used to assess clinical efficacy of Mirtazapine. Serum BDNF at enrolled and after 8 weeks of open treatment was detected. Results Fifty eight patients completed the study, the mean dose of Mirtazapine was （31.3±7.8） mg/d. After 8 weeks of Mirtazapine treatment, HAMD total score, severity of illness, global improvement and efficacy index were decreased significantly compared with before treatment （P 〈 0.01）. The body weight slight increased after treatment, but the difference was not statistical- Iy significant （P 〉 0.05）. BDNF was statistically significant higher than pre-treatment （P 〈 0.01）. The main side effects were excessive sedation, lower extremity discomfort when falling asleep, dizziness, and diarrhea. Conclusion Mirtazap- ine in treatment of elderly depression is safe and effective, and it can increase BDNF levels.