阿立哌唑增效与换用文拉法辛治疗对选择性5-羟色胺再摄取抑制剂治疗抵抗抑郁症的对照研究

Comparison study of aripiprazole augmentation versus venlafaxine in treatment of selective serotonin reuptake inhibitors treatment-resistance depression

目的探讨加用阿立哌唑与换用文拉法辛对选择性5-羟色胺再摄取抑制剂(SSRI)类药物治疗抵抗抑郁症的疗效及安全性。方法 84例SSRI类药物系统治疗后未见显著疗效的抑郁症患者按随机数字表法分为增效组42例和换药组42例。增效组在原治疗方案的基础上加用阿立哌唑(9±5)mg/d治疗,换药组在停用原治疗药物后改用文拉法辛(154±47)mg/d治疗,疗程均为8周。采用汉密尔顿抑郁量表(HAMD-24)和大体评定量表(GAS)评定疗效,以治疗前后HAMD-24减分率≥50%作为判定显效率的依据;采用副反应量表(TESS)评价治疗的安全性。结果治疗8周后,2组患者HAMD-24评分均较治疗前显著减少(P<0.01),GAS评分均较治疗前显著增加(P<0.01)。2组患者治疗8周后HAMD-24评分及GAS评分差异均无统计学意义(P>0.05)。增效组治疗显效率为52%,换药组57%,组间差异无统计学意义(P>0.05)。2组不良反应均较轻微,总体发生率差异无统计学意义(P>0.05)。结论阿立哌唑增效与换用文拉法辛治疗对SSRI类药物治疗抵抗抑郁症均有一定疗效,2种方案的治疗效果及安全性基本相当。

Objective To investigate the curative effect and safety of aripiprazole augmentation and venlafaxine in treatment of selective serotonin reuptake inhibitors（SSRIs）treatment-resistance depression.MethodsEighty-four patients with SSRIs treatment-resistance depression were randomly assigned into two group：42in augmentation group and 42 in switching group.The augmentation group were treated with aripiprazole（9±5）mg/d combined with the original SSRIs treatment and the control group with venlafaxine（154±47）mg/d,and treatment course was 8weeks.Hamilton Depression Scale（HAMD-24）and Global Assessment Scale（GAS）were used to evaluate the curative effect,and the reducing score rate of HAMD-24≥50% was significant advancement.Treatment Emergent Symptom Scale（TESS）was used to evaluate the safety.Results At the end of week 8,the scores of HAMD-24 of the two groups were lower than those before the treatment（P〈0.01）,and the scores of GAS were higher than those before the treatment（P〈0.01）.At the end of week 8,there were no significant difference between the scores of HAMD-24/GAS of the two groups（P〉0.05）.The apparent rate of the augmentation group and switching group were 52% and 57%respectively,and there was no significant difference（P〉0.05）.Adverse reactions of the two groups were milder,and there were no significant differences in the overall incidence.Conclusion The strategies of aripiprazole augmentation and switching to venlafaxine are both effective for SSRI treatment-resistance depression.Their efficacy and safety are approximately equivalent.