南昌治疗抑郁症的医院.pptVIP

抑 郁 症 南昌二七医院高喜翠 内 容 抑郁和睡眠障碍 抑郁与焦虑共病 抑 郁 与 睡 眠 障 碍 抑郁症病人的睡眠障碍 睡眠对抑郁症病人很关键 超过 80% 的抑郁症病人有睡眠障碍 抑郁症病人的睡眠结构的特点： REM 潜伏期缩短 REM 期延长 睡眠效率下降 第 3 and 4 睡眠减少 抗抑郁药对睡眠的疗效 不同抗抑郁药对睡眠的作用迥异 SSRIs 刺激 5-HT2 受体是导致睡眠障碍的一个因素 早期改善睡眠增加病人的依从性 持续失眠导致白天的工作效率下降 抗抑郁药对睡眠的作用 瑞美隆? （米氮平） 睡眠疗效：米氮平 vs. SSRIs (HAMD-17 Factor VI; LOCF) 米氮平 vs SSRIs 生存分析 原有患者数据的生存分析 12 随机, 双盲, SSRI 对照实验 11项研究使用HAMD-17 量表, 1项与西酞普兰对照实验使用MADRS 目的: 分析米氮平和 SSRI 治疗后的起效时间 比较有效率和治愈率 比较第一次达到有效和治愈的时间 使用HAMD分析疗效 米氮平 vs SSRIs 生存分析 米氮平 SSRIs 患者数 (AST) 1485 1485 患者数 (ITT) 1402 1405 女性 56.8% 56.5% 男性 43.2% 43.5% 年龄 45.5 岁 45.3 岁 HAMD-17 ( 25) 58.6% 57.3% HAMD-17 (? 25) 41.3% 42.7% * The most common sleep disturbance associated with a major depressive episode is insomnia. Insomnia is also one of the main criteria in diagnosing depression. The most common sleep EEG abnormalities in depressed patients are: decreased rapid eye movement (REM) latency, increased phasic REM activity, reduced sleep efficiency and decreased or absent stage 3 and 4 (slow wave) sleep. Recovering sleep architecture to a normal situation might avoid the persistence of insomnia after clinical remission or be the trigger to a new depressive episode. 抗抑郁药可使睡眠模式恶化，导致睡眠效率降低。 另一方面，阻断 5-HT2 受体的药物如尼法唑酮和米氮平可能有助于睡眠恢复正常。 References: - Pinder RM, J Clin Psychiatry 1997; 58(11): 501-508 Following the discovery of antidepressants, the pharmacological action of these drugs was explored. It was determined that these antidepressants appeared to work through effects on the neurotransmitters noradrenaline and serotonin. This leads to the mono-amine theory of depression. To date, this hypothesis has remained the cornerstone for the development of antidepressants. Antidepressants that affect both neurotransmitter systems, like Remeron, might therefore have a better efficacy. In the past, the superiority of the dual action concept was already proven by the TCAs. Looking at the schematic model of Remeron, due to the