Selective serotonin re-uptake inhibitor sertraline inhibits bone healing in a calvarial defect model

Bone wound healing is a highly dynamic and precisely controlled process through which damaged bone undergoes repair and complete regeneration. External factors can alter this process, leading to delayed or failed bone wound healing. The findings of recent studies suggest that the use of selective serotonin reuptake inhibitors(SSRIs) can reduce bone mass, precipitate osteoporotic fractures and increase the rate of dental implant failure. With 10% of Americans prescribed antidepressants, the potential of SSRIs to impair bone healing may adversely affect millions of patients’ ability to heal after sustaining trauma. Here, we investigate the effect of the SSRI sertraline on bone healing through pre-treatment with(10 mg·kg-1sertraline in drinking water, n = 26) or without(control, n = 30) SSRI followed by the creation of a 5-mm calvarial defect. Animals were randomized into three surgical groups:(a) empty/sham,(b) implanted with a DermaMatrix scaffold soak-loaded with sterile PBS or(c) DermaMatrix soak-loaded with542.5 ng BMP2. SSRI exposure continued until sacrifice in the exposed groups at 4 weeks after surgery. Sertraline exposure resulted in decreased bone healing with significant decreases in trabecular thickness, trabecular number and osteoclast dysfunction while significantly increasing mature collagen fiber formation. These findings indicate that sertraline exposure can impair bone wound healing through disruption of bone repair and regeneration while promoting or defaulting to scar formation within the defect site.

Comparison of paroxetine and dapoxetine, a novel selective serotonin reuptake inhibitor in the treatment of premature ejaculation

Dapoxetine hydrochloride is a selective serotonin reuptake inhibitor and the first drug approved for the on-demand treatment of premature ejaculation （PE）, Our objective in this study was to characterize the efficacy of on-demand dapoxetine （30 and 60 mg） and daily paroxetine （20 mg） usage in treating PE, We conducted a 1 month study involving a total of 150 patients. Patients were divided into three groups of 50, Group 1 were treated with on-demand dapoxetine （30 mg）, Group 2 with on-demand dapoxetine （60 mg） and Group 3 with daily paroxetine （20 rag）, Our outcome measurement was increased from baseline intravaginal ejaculatory latency time （IELT） after treatment, The IELT increased from baseline to posttreatment by 117%, 117% and 170% in the paroxetine group （P 〈 0,01）, 30 mg dapoxetine group （P 〈 0,01） and 60 mg dapoxetine group （P 〈 0.01）, respectively, The increase from baseline IELT were similar for the 30 mg dapoxetine and paroxetine groups （P 〉 0,05）, while the 60 mg dapoxetine group had a larger posttreatment IELT increase compared with the 30 mg dapoxetine （P〈 0.05） and paroxetine （P〈 0.01） groups, Dapoxetine （60 mg） 1-3 h before planned intercourse is a very effective treatment modality for PE. However, an on-demand dose of 30 mg dapoxetine is no more effective than the currently prescribed paroxetine treatment.

Selective serotonin reuptake inhibitors and Alzheimer’s disease

Given the failure to develop disease-modifying therapies for Alzheimer’s disease(AD),strategies aiming at preventing or delaying the onset of the disease are being prioritized.While the debate regarding whether depression is an etiological risk factor or a prodrome of AD rages on,a key determining factor may be the timing of depression onset in older adults.There is increasing evidence that untreated early-onset depression is a risk factor and that late-onset depression may be a catalyst of cognitive decline.Data from animal studies have shown a beneficial impact of selective serotonin reuptake inhibitors on pathophysiological biomarkers of AD including amyloid burden,tau deposits and neurogenesis.In humans,studies focusing on subjects with a prior history of depression also showed a delay in the onset of AD in those treated with most selective serotonin reuptake inhibitors.Paroxetine,which has strong anticholinergic properties,was associated with increased mortality and mixed effects on amyloid and tau deposits in mice,as well as increased odds of developing AD in humans.Although most of the data regarding selective serotonin reuptake inhibitors is promising,findings should be interpreted cautiously because of notable methodological heterogeneity between studies.There is thus a need to conduct large scale randomized controlled trials with long follow up periods to clarify the dose-effect relationship of specific serotonergic antidepressants on AD prevention.

Relationship between use of selective serotonin reuptake inhibitors and irritable bowel syndrome: A populationbased cohort study

AIM To investigate the relationship between selective serotonin reuptake inhibitor(SSRI)use and the subsequent development of irritable bowel syndrome(IBS).METHODS This retrospective,observational,population-based cohort study collected data from Taiwan’s National Health Insurance Research Database.A total of 19653patients newly using SSRIs and 78612 patients not using SSRIs,matched by age and sex at a ratio of 1:4, were enrolled in the study from January 1,2000 to December 31,2010.The patients were followed until IBS diagnosis,withdrawal from the National Health Insurance system,or the end of 2011.We analyzed the effects of SSRIs on the risk of subsequent IBS using Cox proportional hazards regression models.RESULTS A total of 236 patients in the SSRI cohort(incidence,2.17/1000 person-years)and 478 patients in the comparison cohort(incidence,1.04/1000 person-years)received a new diagnosis of IBS.The mean follow-up period from SSRI exposure to IBS diagnosis was 2.05years.The incidence of IBS increased with advancing age.Patients with anxiety disorders had a significantly increased adjusted hazard ratio(a HR)of IBS(a HR=1.33,95%CI:1.11-1.59,P=0.002).After adjusting for sex,age,urbanization,family income,area of residence,occupation,the use of anti-psychotics and other comorbidities,the overall a HR in the SSRI cohort compared with that in the comparison cohort was1.74(95%CI:1.44-2.10;P<0.001).The cumulative incidence of IBS was higher in the SSRI cohort than in the non-SSRI cohort(log-rank test,P<0.001).CONCLUSION SSRI users show an increased risk of subsequent diagnosis of IBS in Taiwan.

Mouse strain differences in selective serotonin reuptake inhibitors sensitivity correlates with serotonin transporter binding and function

OBJECTIVE Selective serotonin reuptake inhibitors(SSRIs) bind 5-HT transporters,leading to the accumulation of 5-HT and amelioration of depression.Although different mouse strain showed different sensitivity to SSRIs in mouse models of depression,the reason for these strain differences remains unclear.Here,therefore,in the present study,we examined immobility time and locomotor activity in two mouse strains,namely,C57BL/6 J and DBA/2 J mice,and the effects of the SSRIs fluoxetine.Furthermore,we analyzed 5-HT transporter binding and reuptake inhibition in both strains to explore their relationship with the immobility and locomotor activity effects of the three SSRIs in these two mouse strains.METHODS Strain differences in SSRI effects in the tail suspension test(TST) and forced swimming test(FST).To initiate our studies,we sought to confirm that SERT strain variation did not alter SERT protein expression,5-HT recognition,or uptake activity when expressed in C57BL/6 J and DBA/2 J mice.Radioligand binding assays were conducted to determine the affinity of the SSRIs for the 5-HT transporters in the two mouse strains.RESULTS SSRI citalopram dose-dependently reduced immobility time in both the FST and TST in DBA/2 J but not C57BL/6 J mouse strains,whereas fluoxetine showed opposite results.Paroxetine reduced immobility time similarly in both strains.The affinity of citalopram for the 5-HT transporter in DBA/2 J mice was 700-fold higher than that for in C57BL/6 J mice,whereas the affinity of fluoxetine in C57BL/6 J mice was 100-fold higher than that in the DBA/2 J mouse.Furthermore,High citalopram concentrations were required to [3 H]5-HT uptake in C57BL/6 J but not DBA/2 J mouse cortical synaptosomes,whereas fluoxetine also showed opposite results.CONCLUSION Immobility duration depends on 5-HT transporter binding levels,leading to apparent strain differences in immobility time in FST and TST.Furthermore,differences in 5-HT transporter binding may cause variations in SSRI responses on behaviors.SERT mutation mice maintained sensitivity to paroxetine,an antidepressant that is unaffected by the mouse mutation.Therefore,the background strain of these mice likely contributes to the acute behavioral actions of SSRIs in immobility time.These differences may help to explain some of the discrepancies in studies that used these strains of mice to examine the role of 5-HT in mouse models of depression.Future studies should investigate additional neural substrates and molecular mechanisms underlying strain variations in mouse models of depression to help identify genetic predispositions to this disorder in humans.

Fluoxetine,a selective serotonin reuptake inhibitor used clinically,improves bladder function in a mouse model of moderate spinal cord injury

After spinal cord injury,the upward conduction of the spinal cord is lost,resulting in the loss of micturition control,which manifests as detrusor sphincter dyssynergia and insufficient micturition.Studies have shown that serotonergic axons play important roles in the control of the descending urination tract.In this study,mouse models of moderate spinal cord contusions were established.The serotonin agonists quipazine(0.2 mg/kg),8-hydroxy-2-(di-n-propylamino)tetralin(8-OH-DAPT,0.1 mg/kg),buspirone(1 mg/kg),sumatriptan(1 mg/kg),and rizatriptan(50 mg/kg),the serotonin reuptake inhibitors fluoxetine(20 mg/kg)and duloxetine(1 mg/kg),and the dopamine receptor agonist SKF-82197(0.1 mg/kg)were intraperitoneally administered to the model mice 35 days post-injury in an acute manner.The voided stain on paper method and urodynamics revealed that fluoxetine reduced the amount of residual urine in the bladder and decreased bladder and external urethral sphincter pressure in a mouse model of moderate spinal cord injury.However,fluoxetine did not improve the micturition function in a mouse model of severe spinal cord injury.In contrast,the other serotonergic drugs had no effects on the micturition functions of spinal cord injury model mice.This study was ethically approved by the Institutional Animal Care and Use Committee of Jiangsu Province Hospital of Chinese Medicine(approval No.2020DW-20-02)on September 11,2020.

Serotonin syndrome controversies:A need for consensus

Serotonin syndrome(SS)is a drug-induced clinical syndrome resulting from increased serotonergic activity in the central nervous system.Although more than seven decades have passed since the first description of SS,it is still an enigma in terms of terminology,clinical features,etiology,pathophysiology,diagnostic criteria,and therapeutic measures.The majority of SS cases have previously been reported by toxicology or psychiatry centers,particularly in people with mental illness.However,serotonergic medications are used for a variety of conditions other than mental illness.Serotonergic properties have been discovered in several new drugs,including over-the-counter medications.These days,cases are reported in non-toxicology centers,such as perioperative settings,neurology clinics,cardiology settings,gynecology settings,and pediatric clinics.Overdoses or poisonings of serotonergic agents constituted the majority of the cases observed in toxicology or psychiatry centers.Overdose or poisoning of serotonergic drugs is uncommon in other clinical settings.Patients may develop SS at therapeutic dosages.Moreover,these patients may continue to use serotonergic medications even if they develop mild to moderate SS due to several reasons.Thus,the clinical presentation(onset,severity,and clinical features)in such instances may not exactly match what toxicologists or psychiatrists observe in their respective settings.They produce considerable diversity in many aspects of SS.However,other experts discount these new developments in SS.Since SS is a potentially lethal illness,consensus is required on several concerns related to SS.

Possible association of the 5-HTTLPR serotonin transporter promoter gene polymorphism with premature ejaculation in a Turkish population

We evaluated the genotypes of the serotonin transporter gene （5-HTT） in patients with premature ejaculation （PE） to determine the role of genetic factors in the etiopathogenesis of PE and possibly to identify the patient subgroups. A total of 70 PE patients and 70 controls were included in this study. All men were heterosexual, had no other disorders and were either married or in a stable relationship. PE was defined as ejaculation that occurred within 1 min of vaginal intromission. Genomic DNA from patients and controls was analyzed using polymerase chain reaction, and allelic variations of the promoter region of the serotonin transporter gene （5-HTTLPR） were determined. The 5-HTTLPR （serotonin transporter promoter gene） genotypes in PE patients vs. controls were distributed as follows： L/L 16% vs. 17%, L/S 30% vs. 53% and S/S 54% vs. 28%. We examined the haplotype analysis for three polymorphisms of the 5-HTTLPR gene： LL, LS and SS. The appropriateness of the allele frequencies in the 5-HTTLPR gene was analyzed by the Hardy-Weinberg equilibrium using the Z-test. The short （S） allele of the 5-HTTLPR gene was significantly more frequent in PE patients than in controls （P 〈 0.05）. We suggest that the 5-HTTLPR gene plays a role in the pathophysiology of all primary PE cases. Further studies are needed to evaluate the relationship between 5-HTTLPR gene polymorphism and patient subgroup （such as primary and secondary PE） responses to selective serotonin reuptake inhibitors as well as ethnic differences.

Differences of Plasma Levels of Tryptophan, Serotonin, 5-Hydroxyindole Acetic Acid, and Kynurenine between Healthy People and Patients of Major Monopolar Depression at Various Age and Gender

Background: It is not well analyzed whether there are differences in plasma levels of tryptophan (TRP) metabolites between healthy control people (HC) and patients of major monopolar depression (MMD). Methods: Ultra high-speed liquid chromatography/mass spectrometry has been used for the simultaneous determination of plasma levels of tryptophan metabolites in depressive patients. Results: There are no significant differences between plasma levels of TRP between HC and MMD. Plasma levels of TRP of HC are higher in young men, young women, old men, and old women in this order. Serotonin (5-HT) levels are higher in MMD than HC. Plasma levels of 5-HIAA of HC are also higher than those of patients of MMD. Plasma levels of kynurenine (KYN) of healthy old men and old women are higher than those of young men and old women. Plasma levels of KYN are higher in old women and young men of MMD than those of HC. Conclusion: Plasma levels of 5-HT are higher in patients of MMD than those of HC, which may suggest that use of drugs inhibiting the 5-HT transportation may increase plasma levels of 5-HT in MMD.

基于美国FAERS数据库抗抑郁药物与胎儿及新生儿的不良事件信号分析

目的基于美国食品药品监督管理局不良事件报告系统(FAERS)挖掘抗抑郁药物的使用与胎儿及新生儿不良事件的风险信号,为临床安全合理用药提供参考。方法筛选FAERS数据库2004年1月1日至2022年12月31日中怀疑抗抑郁药的不良事件报告,并通过报告比值比(ROR)法和比例报告比值比(PRR)法挖掘抗抑郁药与胎儿及新生儿之间的不良事件信号。结果共有14492例儿胎儿及新生儿异常的病例纳入研究,其中胎儿组5546例,新生儿组病例8946例。药物方面,分别有68.97%、56.35%的胎儿不良事件信号和新生儿不良事件信号为选择性5-羟色胺再摄取抑制剂(SSRI)类抗抑郁药产生。不良事件方面,51.72%胎儿不良事件信号与羊水相关,20.99%的新生儿不良事件信号与呼吸系统异常相关。对产生的不良事件信号进行二次筛选后,西酞普兰和文拉法辛信号突出,且存在说明书未载明信号。结论抗抑郁药物的整体信号特征与现有的安全性资料基本一致,但通过分组分析仍然发现了如胎儿羊水异常、新生儿心脏方面等说明书未载明不良事件,临床使用时应重点关注。

5-羟色胺选择性重摄取抑制剂联合计算机化的认知训练治疗伴有认知障碍的老年抑郁症患者的研究

目的探讨5-羟色胺选择性重摄取抑制剂(SSRI)联合计算机化的认知训练(CCT)对伴有认知障碍的老年抑郁症(LLD)患者的临床治疗效果。方法本研究为前瞻性随机对照临床研究。选取2021年5月至2022年12月于首都医科大学附属北京安定医院门诊及住院治疗的118例伴有认知障碍的LLD患者,按照随机数表法分为干预组(57例)和对照组(61例)。干预组给予临床常规SSRI类抗抑郁药治疗联合CCT干预,对照组给予临床常规SSRI类抗抑郁药治疗联合空白对照方法,两组均治疗12周。分别在治疗前及治疗后8、12周对两组患者进行阿尔茨海默病认知评估量表(ADAS-cog)、老年抑郁量表(GDS)及日常生活能力量表(ADL)评分,以评估其认知功能、精神心理状况及社会功能。结果在治疗后8周及12周时,两组的ADAS-cog、GDS量表评分均明显低于治疗前,且干预组明显低于对照组,差异均有统计学意义(P<0.05)。治疗后8周及12周时,干预组的ADL评分明显高于治疗前,且治疗后12周干预组的ADL评分明显高于对照组,差异均有统计学意义(P<0.05),而对照组治疗前后的ADL评分比较差异无统计学意义(P>0.05)。结论SSRI类抗抑郁药联合CCT治疗能够显著改善伴有认知障碍的LLD患者的认知功能和抑郁症状,可作为该类人群的有效选择。

浙江省精神专科医院抗抑郁药临床综合评价与遴选专家共识

目的引导和推动浙江省精神专科医院规范开展抗抑郁药的临床综合评价与遴选工作。方法浙江大学医学院附属精神卫生中心联合杭州市药事管理质量控制中心及浙江省内7家精神专科医院,广泛征求临床专家和药学专家的意见与建议,撰写了《浙江省精神专科医院抗抑郁药临床综合评价与遴选专家共识》,并以13种5-羟色胺再摄取抑制剂(SSRI)和5-羟色胺去甲肾上腺素再摄取抑制剂(SNRI)为例进行试点评价。结果该共识从药学特性、安全性、有效性、经济性、创新性和其他属性6个维度对纳入的抗抑郁药进行了系统评价,并在每个维度下进行二级赋分。结论该共识的制订为抗抑郁药的快速临床综合评价与遴选提供了参考依据,同时引导和推动了相关医疗机构规范开展抗抑郁药的临床综合评价与遴选工作,以满足多元化的临床用药需求,促进临床合理用药。

盐酸文拉法辛缓释胶囊致低钠血症1例分析

目的探讨文拉法辛导致低钠血症的不良反应及影响因素,为临床安全用药提供参考。方法通过对1例使用盐酸文拉法辛缓释胶囊导致低钠血症病例进行分析,检索同类文献发表情况,并提出用药建议。结果患者长期使用文拉法辛治疗前庭性偏头痛5年后反复出现低钠血症,停用文拉法辛和对应补钠治疗后血钠逐渐恢复至正常,考虑为文拉法辛引起低钠血症。结论文拉法辛是临床上用于抑郁症治疗的主要药物之一,医生应关注文拉法辛引起低钠血症的风险,熟悉该药的适应证、禁忌证、药物相互作用和疗程,特别是高龄、女性、使用利尿剂等药物和既往有低钠血症病史的患者,用药期间定期监测电解质,从小剂量开始给药,尽早发现药品不良反应,确保患者用药安全。

盐酸达泊西汀治疗早泄的临床观察

目的:比较盐酸达泊西汀及舍曲林治疗早泄患者的疗效及不良反应。方法:门诊就诊的早泄患者按2∶1比例随机分配接受盐酸达泊西汀(30 mg,按需服用,n=78)或舍曲林(50 mg,每日1次,n=39)治疗,4周后随访,记录用药前后的阴道内射精潜伏时间(IELT),用药后临床总体印象变化(CGIC)评分,并记录不良反应。结果:经治疗后盐酸达泊西汀组及舍曲林组IELT均显著增加[盐酸达泊西汀:(0.87±0.31)min延长至(2.84±0.86)min;舍曲林:(0.84±0.28)min延长至(2.71±0.92)min]。应用CGIC评分,用药后效果很好或好的比率分别为36.5%及37.5%(盐酸达泊西汀vs舍曲林);CGIC评价有效(很好、好、稍好)的比率分别为63.5%和71.9%。舍曲林组头晕、恶心、头痛及腹泻的发生率稍高于盐酸达泊西汀组但差异不具显著性,但舍曲林组疲劳、嗜睡以及口干的发生率显著高于盐酸达泊西汀组(P<0.05)。结论:按需口服盐酸达泊西汀治疗早泄患者安全有效。

选择性5-羟色胺再摄取抑制剂治疗早泄的有效性和安全性系统评价

目的:评价选择性5-羟色胺再摄取抑制剂(SSRIs)治疗早泄的有效性和安全性。方法:采用Cochrane系统评价方法,电子检索MEDLINE(1950年1月至2008年3月)、EMBASE(1980年1月至2008年3月)、Cochrane图书馆(2008年第1期)和中国期刊全文数据库(1979年1月至2008年3月),并手工检索已发表和未发表试验,筛选和纳入SSRIs治疗早泄的随机对照试验(RCT)和随机交叉试验(RT)。由2名评价者独立评价纳入文献的方法学质量,对同质文献采用RevMan5.0软件进行Meta分析。结果:共纳入文献22篇,共包括研究病例4291例。Meta分析显示:舍曲林、氟西汀、帕罗西汀、西酞普兰、达伯西汀、三氟戊肟胺对阴道内射精潜伏时间(IELT)改变值的加权均数差WMD(95%CI)分别为2.63(1.80,3.46)、2.21(1.50,2.92)、4.31(2.71,5.91)、3.82(3.39,4.25)、1.57(1.31,1.84)、0.01(-0.71,0.73);前5者对患者性生活满意率的相对危险度RR(95%CI)分别为1.65(1.12,2.43)、2.93(0.50,17.31)、3.08(2.27,4.17)、2.48(1.99,3.09)、2.93(2.36,3.65);对配偶性生活满意率的RR(95%CI)分别为1.47(0.98,2.21)、2.88(0.38,21.77)、4.81(3.15,7.36)、5.38(3.75,7.72)、2.91(1.09,7.78)。结论:现有证据显示,现有SSRIs除三氟戊肟胺外均能不同程度地延长IELT,帕罗西汀、西酞普兰、达伯西汀能同时提高患者及配偶的性生活满意度,由于存在较多不良反应,应用时需注意。由于纳入文献存在选择偏倚、发表偏倚的中度可能性,可能在一定程度上影响结果的证据强度,故应谨慎看待上述结论,期待高质量的RCT提供更可靠的证据。

选择性5-羟色胺再摄取抑制剂对抑郁症患者睡眠结构的影响及与临床疗效的关系研究

目的探究选择性5-羟色胺再摄取抑制剂(SSRIs)对抑郁症患者睡眠结构的影响及与临床疗效的关系。方法从多导睡眠图(PSG)数据库选择了26例接受SSRIs治疗2周以上的抑郁症患者(治疗组),并同时选择了24例近3个月未接受药物治疗的抑郁症患者(未治疗组)。评估患者睡眠情况,采用汉密尔顿抑郁量表24项版本(HAMD-24)评估患者治疗前后的抑郁状况,采用Logistic回归分析抑郁症患者睡眠结构变化与临床疗效的关系。结果治疗组和未治疗组的睡眠长度、睡眠潜伏期、非快速动眼时相睡眠(NREM)Ⅱ期与Ⅲ期的睡眠比例差异均无统计学意义(P>0.05)。经过SSRIs治疗,治疗组进入快速动眼时相(REM)的时间与未治疗组相比缩短〔(77±30)min vs.(146±64)min〕,差异有统计学意义(P=0.000),并进入正常范围;治疗组的NREMⅠ期睡眠比例与治疗组相比〔(14±5)%vs.(18±8)%〕和微觉醒指数(AI)〔(14±5)次/h vs.(18±6)次/h〕均减少,但AI仍高于正常值(<5次/h),差异均有统计学意义(P<0.05)。治疗组与未治疗组HAMD-24得分间差异有统计学意义〔(17±6)分vs.(27±10)分,P=0.007〕。Logistic回归显示治疗组患者的REML越短〔OR=0.627,95%CI(0.517,0.923)〕和AI越低〔OR=0.839,95%CI(0.721,0.987)〕,就越容易显示出临床疗效。结论抑郁症的REM睡眠异常应该是抑郁症的核心睡眠节律异常,支持了抑郁症的睡眠时相前移假说;睡眠结构的改变影响临床疗效。

疏肝养心针刺法对选择性5-羟色胺再摄取抑制剂治疗抑郁症的增效作用及其对炎性细胞因子的影响研究

目的探讨疏肝养心针刺法对选择性5-羟色胺再摄取抑制剂(SSRIs)治疗抑郁症的增效作用以及其对血清5-羟色胺(5-HT)及辅助性T1细胞(Th1细胞)/辅助性T2细胞(Th2细胞)分泌的炎性细胞因子的影响。方法选取2013年1—12月杭州市第七人民医院精神科住院的抑郁症患者120例为研究对象,采用随机数字表法分为药物组60例和针药组60例,另选取同时期体检健康者60例为正常组。药物组和针药组患者分别于治疗前及治疗后1、2、4、6周评定蒙哥马利抑郁评定量表(MADRS)评分,治疗后1、2、4、6周评定抗抑郁药副反应量表(SERS)评分,评估临床疗效及不良反应情况,正常组、药物组和针药组分别于治疗前、治疗后6周检测血清5-HT及白介素(IL)-1β、IL-6、IL-4、IL-10水平。结果治疗前,药物组与针药组患者MADRS评分比较,差异无统计学意义(P>0.05)。治疗后1、2、4、6周,针药组MADRS评分较药物组降低(P<0.05)。治疗后1、2、4、6周,针药组SERS评分较药物组降低(P<0.05)。治疗前,药物组和针药组血清5-HT、IL-4、IL-10水平较正常组降低,IL-1β、IL-6水平较正常组升高(P<0.05);药物组与针药组血清5-HT、IL-1β、IL-6、IL-4、IL-10水平比较,差异无统计学意义(P>0.05)。治疗后,针药组血清5-HT、IL-4、IL-10水平较药物组升高,血清IL-6水平较药物组降低(P<0.05)。结论疏肝养心针刺法能够快速、有效地增强SSRIs治疗抑郁症的临床疗效、减轻其不良反应,并能有效调节血清5-HT及Th1细胞/Th2细胞分泌的炎性细胞因子的失衡。

70例惊恐障碍患者的医疗费用调查

目的 调查惊恐障碍的医疗费用及选择性 5羟色胺再吸收抑制剂 (Selectiveserotoninreuptakeinhibitors ,SSRIs)对惊恐患者的疗效。方法 调查 70例患者的医疗费用、病程、所做的主要辅助检查的种类及次数。同时用焦虑、抑郁量表观察了SSRIs类药物对惊恐障碍患者的治疗效果。结果 惊恐障碍的患者有较长的病程 ,病程中接受了很多不必要的辅助检察同时花费了大量的医疗费用。SSRIs类药物能明显降低惊恐障碍患者焦虑、抑郁的评分。结论 惊恐障碍患者在确诊前有较长的病程 ,花费了大量的医疗费用。SSRIs是一种治疗惊恐障碍的安全。

针刺疗法对选择性5-羟色胺再摄取抑制剂抗抑郁效应的影响

目的评价针刺疗法对选择性5-羟色胺再摄取抑制剂(SSRIs)类药物抗抑郁效应的影响。方法将60例抑郁症患者随机分为对照组(30例)和治疗组(30例),对照组和治疗组均选用1种SSRIs类药物口服,治疗组在药物治疗的基础上加针刺疗法。连续治疗6周,采用汉密尔顿(HAMD)抑郁量表、抑郁自评量表(SDS)、艾森贝格(Asberg)抗抑郁剂不良反应量表进行疗效评价。结果与对照组比较,治后6周末治疗组的愈显率提高了33.4%(P<0.05);治疗组HAMD量表积分降低,焦虑/躯体化和睡眠障碍因子在治后1周末、治后6周末交互作用的趋势不同(P<0.05);6周末治疗组SDS自评分降低,且减分率比提高了19.23%(P<0.05);治后6周末治疗组Asberg积分平均下降3.77分,对照组平均下降0.07分(P<0.05)。结论针刺疗法能提高SSRIs类药物抗抑郁效应,降低其不良反应。

认知行为治疗联合药物治疗广泛性焦虑障碍的随机单盲对照试验

目的:评估认知行为治疗(CBT)联合选择性5-羟色胺再摄取抑制剂(SSRI)类抗抑郁药治疗广泛性焦虑障碍与单纯使用SSRI类药物的疗效差异。方法:选择某三级甲等精神专科医院门诊符合ICD-10广泛性焦虑障碍诊断标准的48例患者,随机分为联合治疗组和单纯药物组,治疗周期为24周。采用汉密顿焦虑量表(HAMA)评估疗效,采用广义估计方程对两组间临床疗效的差异进行检验。结果:两组各入组24例患者,至24周末联合治疗组脱落8例,单纯药物组脱落11例。控制性别、年龄、病程、HAMA基线得分后,联合治疗组的疗效优于单纯药物组(P<0.001),OR值即疗效好一个等级的可能性之比为21.83(95%CI:5.92～80.41)。联合治疗组患者脱落与疗效无关(P>0.05),治疗间隔为每6周1次时的脱落率最高。而单纯药物组未脱落患者的治疗疗效优于脱落患者(P<0.05),OR值为5.82(95%CI:1.44～23.63)。结论:认知行为治疗联合药物治疗广泛性焦虑障碍的疗效优于单独药物治疗,单纯药物组患者脱落与疗效欠佳有关,而联合治疗组脱落与维持期中CBT治疗间隔时间较长有关。