米氮平抑郁症与睡眠障碍_培训课件.ppt

* * * Pick combination treatment out and mention workof Blier on mirtazapine with fi paroxetine (see presentation ECNP 2003) Explain that most often treatment is started with a single acting AD(switching to or adding the dual acting agent later on) . It seems however also logical to start with the dual acting AD. * * The most common sleep disturbance associated with a major depressive episode is insomnia. Insomnia is also one of the main criteria in diagnosing depression. movement (REM) latency, increased phasic REM activity, reduced sleep efficiency and decreased or absent stage 3 and 4 (slow wave) sleep. 有人研究认为, 抑郁症睡眠维持障碍、早醒与体重减轻、精神运动激越是同时存在的,提示抑郁症患者的中枢神经系统的唤醒作用增强。而使中枢神经系统唤醒作用增强的生物学改变,如去甲肾上腺素能及促肾上腺皮质激素释放因子活性过度等,可能是抑郁症睡眠障碍的发病机理。 * Schatzberg等(1995)发现抑郁患者在患病期和缓解期都有中枢生长激素水平对可乐定刺激的反应迟钝。后者是一种选择性α2肾上腺素受体的激动剂,因此认为抑郁症存在中枢α2受体的低敏,且可能是重性抑郁的特征性标志。抑郁患者的快动眼(REM)睡眠也显示对可乐定反应迟钝。此称为可乐定快动眼睡眠抑制试验(CREST)。而可乐定对快动眼睡眠的抑制也是通过α2受体介导的。在经米氮平治疗后缓解的原发性抑郁患者中其CREST回复正常。而经氟伏草胺治疗的抑郁患者快动眼睡眠对可乐定反应迟钝更趋于明显。这一效应可能是米氮平改善睡眠的机制之一。其原理也许是由于米氮平阻断α2受体后产生的继发性α2受体上调的缘故。米氮平阻断5-HT3受体的作用也是其改善睡眠的机制。 * At the end of the treatment period, both drugs were effective in reducing overall symptoms of depression. However, in the first four weeks, several efficacy measures indicated a statistically and clinically significant superiority of mirtazapine. After 1 week, improvement in 17-HAMD was larger with mirtazapine (d = -5,9) compared to paroxetine d = -3,6). (continued next slide) * The decrease from baseline on the HAMD according to factor analysis (factor IV; sleep disorder) was larger in the mirtazapine group than in the venlafaxine group throughout the treatment period, with statistical significance already at week 1 until the end of the treatment period. This provides evidence for the pharmacological findings that the blocking ability of mirtazapine on the 5-HT2 receptors is among others responsible for its beneficial effects on sleep patterns. * Sleep efficiency