米氮平与文拉法辛治疗首发抑郁症的疗效及对性功能的影响

Comparison of therapeutic efficacy and effect on sexual function of mirtazapine and venlafaxine in treatment of first episode depression

目的比较米氮平与文拉法辛治疗首发抑郁症的疗效及对性功能的影响。方法选取住院接受米氮平（起始剂量7.5mg/d,2周后加至目标剂量30-45mg/d,睡前服用）或文拉法辛（起始剂量75mg/d,4-7d内加至150或225mg/d,早餐后服用）治疗的首发抑郁症患者各119例,应用亚利桑那性体验量表（ASEX）、汉密顿抑郁量表17项（HAMD17）和副反应量表（TESS）分别评定并比较两组患者的性功能、疗效以及不良反应情况。结果入院时,两组患者性功能障碍发生率均为72.3%;治疗第8周,米氮平组性功能障碍发生率低于文拉法辛组（P〈0.05）。与入院时比较,两组治疗第2、4、8周ASEX评分均明显下降（均P〈0.05）;两组间比较,米氮平组均低于文拉法辛组（均P〈0.05）。治疗8周,米氮平组有效率、痊愈率（79.8%、49.6%）与文拉法辛组（80.7%、51.3%）比较,差异均无统计学意义（均P〉0.05）。与入院时比较,两组患者治疗第1、2、4、8周HAMD17评分均明显下降（均P〈0.05）;两组间比较差异均无统计学意义（均P〉0.05）。米氮平组与文拉法辛组不良反应发生率分别为41.2%和40.3%,差异无统计学意义（P〉0.05）。结论米氮平与文拉法辛治疗首发抑郁症的疗效相当,但在改善性功能方面米氮平优于文拉法辛。

Objective To compare the therapeutic efficacy and effect on sexual function of mirtazapine and venlafaxine in treatment of first episode depression. Methods Two hundred and thirty eight patients diagnosed as first episode depression were randomly assigned to receive mirtazapine（n=119） or venlafaxine（n=119） for 8 weeks. The efficacy, sexual function and adverse effects were evaluated by Hamilton Rating Scale for Depression-17 Items（HAMD17）, Arizona Sexual Experience Scale（ASEX） and Treatment Emergent Symptom Scale（TESS）, respectively. Results The remission and response rates were 49.6%, 79.8% in mirtazapine group and 51.3%, 80.7% in venlafaxine group at the end of week 8（P〉0.05）. The ASEX score was significantly lower in mirtazapine group than that in venlafaxine group at the end of week 2, 4 and 8（P〈0.05）. The HAMD17 scores were significantly decreased at the end of week 1, 2, 4, 8 in both groups（P〈0.05） compared to those before treatment, but there were no significant differences in efficacy between the two groups（P〉0.05）. The incidence of adverse effects was 41.2% in mirtazapine group and40.3% in venlafaxine group（P〉0.05）. Conclusion Mirtazapine is effective and safe as venlafaxine in treatment of patients with first episode depression, and it is likely to induce sexual dysfunction less than venlafaxine.