氯胺酮联合帕罗西汀对伴有自杀意念重度抑郁症效果

KETAMINE COMBINED WITH PAROXETINE FOR SEVERE DEPRESSION PATIENTS WITH SUICIDE IDEATION

目的探讨单次静滴氯胺酮联合帕罗西汀治疗伴有自杀意念的重度抑郁症病人有效性和安全性。方法选择汉密尔顿抑郁量表（HAMD）评分≥24分抑郁症病人25例,随机分成2组,A组12例,给予氯胺酮单次静滴加帕罗西汀口服治疗;B组13例,给予帕罗西汀口服治疗。两组分别于治疗前及治疗后1h、2h、4h、1d、3d、7d、14d、21d、28d,采用HAMD评定疗效,采用自杀意念量表（SSI）评估自杀风险。结果治疗14、21、28d,A组HAMD评分均低于治疗前,差异有显著性（F=4.39,P〈0.05）;治疗21、28d,B组HAMD评分均低于治疗前,差异有显著性（F=8.78,P〈0.05）;治疗后2h、4h、1d、3d、7d、14d,A组HAMD评分均低于B组,差异有显著性（t=2.118~3.327,P〈0.05）。治疗后4h、1d、3d、7d、14d、21d、28d,A组SSI评分均低于治疗前,差异有显著性（F=23.83,P〈0.05）;治疗后7、14、21、28d,B组SSI评分均低于治疗前,差异有显著性（F=30.59,P〈0.01）;治疗后2h、4h、1d、3d,A组SSI评分均低于B组,差异有显著性（t=2.200~3.512,P〈0.05）。结论氯胺酮联合帕罗西汀治疗伴有自杀倾向的重度抑郁症安全、有效,并可缩短抗抑郁治疗的起效时间。

Objective To investigate the efficacy and safety of single intravenous drop of ketamine plus paroxetine in the treatment of major depressive disorder （MDD） with suicide ideaton. Methods Twenty-five patients with severe MDD- Hamilton Depression Scale （HAMD） score ≥24-were selected and randomized to group A （n=12） and group B （n=13）. The patients in group A were treated with a single i.v. drop of ketamine plus oral paroxetine; those in group B were treated with oral paroxetine. The efficacy and risk of suicide in patients of the two groups were assessed using HAMD and Scale for Suicide Ideation （SSI）, respectively, at baseline and 1, 2, 4, 24 and 72 h and 7, 14, 21 and 28 d after therapy. Results On days 14,21 and 28 after therapy, HAMD scores in group A were lower than that before treatment （F=4.39,P〈0.05）, and on days 21 and 28 after treatment, HAMD scores in group B were lower than that before treatment （F=8.78,P〈0.05）. From 2 hours to 14 d after treatment, the HAMD scores in group A were lower than that in group B （t=2.118-3.327,P〈0.05）. Four hours, one, three, seven,14,21 and 28 d after the treatment, SSI scores of group A were lower than that before therapy （F=23.83,P〈0.05）; and that in group B were lower on days 7,14,21 and 28 after treatment versus before therapy. The SSI scores in group A- 2 h, 4 h, 1 d and 3 d after treatment-were lower than that in group B, the differences were statistically significant （t=2.200-3.512,P〈0.05）. Conclusion Ketamine plus paroxetine were safe and effective in the treatment of major depressive disorder with suicidal tendency, this kind of therapy can shorten the onset time of antidepressant treatment.