碳酸锂与丙戊酸镁联合选择性5-羟色胺抑制剂对抑郁症的疗效及转躁的预防

Safety and effort of lithium carbonate and valproic acid magnesium with selective serotonin and switching

目的探讨碳酸锂与丙戊酸盐联合或辅助治疗抑郁症的效果及预防转躁的作用。方法选取2012年5月-2014年4月在山西省精神卫生中心门诊或住院的符合美国精神病学会(APA)《精神障碍诊断与统计手册(第4版)》(DSM-IV)抑郁症诊断标准的120例患者,按照随机数字表法分为A、B两组,均给予SSRI类抗抑郁药物,A组接受一种SSRI联合碳酸锂治疗,B组接受一种SSRI联合丙戊酸镁缓释剂治疗,疗程8周。采用汉密尔顿抑郁量表(HRSD)和杨氏躁狂评定量表(YMRS)评定抑郁症状和躁狂症状,采用副反应量表(TESS)评定治疗过程中出现的药物副反应。结果治疗1周后,两组HRSD评分均下降[A组治疗前(28.5±8.2)分,1周后(23.9±7.7)分;B组治疗前(27.9±7.9)分,1周后(22.9±6.9)分,P均<0.05],治疗8周后两组HRSD评分均较治疗前低,差异有统计学意义(P<0.01),两组比较差异无统计学意义(P>0.05)。两组有效率和痊愈率差异无统计学意义(66.1%vs.68.9%;30.6%vs.31.0%,P均>0.05),两组TESS评分差异无统计学意义[(2.6±1.5)分vs.(2.5±1.4)分,P>0.05],两组转相率差异无统计学意义(4.8%vs.6.8%,P>0.05)。结论碳酸锂与丙戊酸盐在联合或辅助治疗抑郁症的过程中可降低抗抑郁药物相关的转相,副反应相当。

Objective To explore the effects of lithium carbonate and valproic acid salt in treatment and preventing switching of depression. Methods 120 outpatient and inpatient patients were recruited from May 2012 to April 2014 as the research object,which were randomly divided into two groups,both groups of patients were given SSRI antidepressants,group A were treated by SSRI joint lithium carbonate,group B were treated by SSRI joint magnesium valproate. All patients were assessed by HRSD and YMRS. Results The first week after the treatment,HRSD of both groups were decreased[Group A:( 28. 5 ± 8. 2) vs.( 23. 9 ± 7. 7),P < 0. 05,Group B( 27. 9 ± 7. 9) vs.( 22. 9 ± 6. 9),P < 0. 05 ],after 8 weeks treatment HRSD of both groups were decreased significantly[Group A( 28. 5 ± 8. 2) vs.( 10. 1 ± 6. 2,P < 0. 01),Group B( 27. 9 ± 7. 9) vs.( 29. 8 ± 5. 1),P < 0. 01]. No statistical difference between the two groups was found. There is no statistical significance in effective rate and remission rate between two groups,( 66. 1%,68. 9%,χ2= 0. 11,P > 0. 05; 30. 6% vs. 31. 0%,P > 0. 05). TESS was no difference between two groups [( 2. 6 ± 1. 5) vs.( 2. 5 ± 1. 4),P >0. 05]. No difference in switching rate was found( 4. 8% vs. 6. 8%,P > 0. 05). Conclusion Lithium carbonate and magnesium valproate may have its beneficial aspects in therapeutic and preventing switching without difference in side effects.