文拉法辛缓释剂与氯米帕明用于首发抑郁症首次抗抑郁治疗无效者的疗效比较 Comparison of extended-release venlafaxine with clomipramine in treatment of depressive patients with failure of initial antidepressant therapy.pdfVIP

江医学2012 年第34 卷第14 期 文拉法辛缓释剂与氯米帕明用于 首发抑郁症首次抗抑郁治疗无效 者的疗效比较 钱敏才 沈鑫华 富荣 孙菊水 朱毅平 郭玮刚 王春生 杨剑虹 林敏 任列 【摘要 】 目的 了解首发抑郁症首次治疗无效后换药治疗的疗效和不良反应。 方法 首发抑郁症患者首次治疗无效后的患 者进入第二轮换药治疗。首次治疗用艾司西酞普兰无效 13 例，舍曲林无效18 例，瑞波西汀无效20 例，共计51 例，均换为文拉法辛缓 释剂；首次治疗用文拉法辛无效9 例， 洛西汀无效 17 例，共计26 例，均换为氯米帕明。均再治疗6 周。疗效采用汉密尔顿抑郁量表 （HAMD ）17 项及 Montgomery-Asberg 抑郁量表（MADRS ）评定，不良反应采用治疗时出现的症状量表（TESS ）和实验室检查来评 定。结果 两组患者的HAMD、MADRS 均在2 周末较基线减分有明显下降，差异均有统计学意义 （均P ＜0.05 ）。两组间各时点 HAMD、MADRS 评分、减分率的差异均无统计学意义（均P ＞0.05 ）。两组疗效的差异无统计学意义（P ＞0.05 ）。氯米帕明组震颤、口 干、视力模糊、便秘、心电图异常等方面不良反应发生率较文拉法辛组高。 结论 首发抑郁症首次治疗用艾司西酞普兰、舍曲林、瑞波 西汀无效后，第二轮换为文拉法辛缓释剂；首次治疗用文拉法辛、 洛西汀无效后，第二轮换为氯米帕明均仍能取得一定的治疗效果， 两种换药方案疗效相似，但氯米帕明不良反应较多。 【关键词】 抑郁症 文拉法辛 氯米帕明 疗效 不良反应 Comparison of extended-release venlafaxine with clomipramine in treatment of depressive patients with failure of initial antidepressant therapy China 【Abstract 】 Objective To compare the efficacy and side effects of extended-release venlafaxine with clomipramine in treatment of depressive patients who failed to initial antidepressant therapy. Methods Patients with first episode of depression who did not respond to escitalopram (N=13), sertraline (N=18) and reboxetine (N=20) for initial antidepressant therapy were as- signed to receive sustained-release venlafaxine; and patients who did not respond to venlafaxine (N=9), duloxetine (N=17) were assigned to receive clomipramine. All patients were treated for another 6 weeks. Efficacy were assessed with Hamilton Depres- sive Scale (HAMD-17) and Montgomery-Asberg Depressive Scale (MADRS). Side effects were evaluated by Treatment Emergent Symptom Scale (TESS) and laboratory tests. Results The scores of HAMD and MADRS after 2 weeks of treatment in both groups were significantly lower than the baseline scores (P＜0.05); there were no significant differences at time points between two groups (P