六种抗抑郁药治疗抑郁症首次发病患者疗效和不良反应的比较
륙충항억욱약치료억욱증수차발병환자료효화불량반응적비교
Efficacy and adverse reactions of 6 kinds of antidepressants for the treatment of first-episode depression
  • 万方数据
    中华精神科杂志 중화정신과잡지
    CHINESE JOURNA OF PSYCHIATRY
    2012年 4期 223-227 ,共5页

    钱敏才%沈鑫华%钮富荣%孙菊水%朱毅平%郭玮刚%王春生%杨剑虹%林敏%任列

    전민재%침흠화%뉴부영%손국수%주의평%곽위강%왕춘생%양검홍%림민%임렬

    抑郁症%治疗结果%药物副反应报告系统 抑鬱癥%治療結果%藥物副反應報告繫統
    억욱증%치료결과%약물부반응보고계통
    Depressive disorder%Treatment outcome%Adverse drug reaction reporting systems
    目的 探讨6种常用抗抑郁药治疗抑郁症首次发病患者的疗效和不良反应.方法 将307例符合抑郁症首次发病患者随机分为6组,分别使用艾司西酞普兰[剂量5～20 mg/d,6周末平均剂量(12.74±4.17)mg/d]、文拉法辛[75～225 mg/d,6周末平均剂量(144.75±39.81) mg/d]、度洛西汀(固定剂量60md)、米氮平[7.5～45.0 mg/d,6周末平均剂量(28.94±8.92)mg/d]、瑞波西汀[4～12 mg/d,6周末平均剂量(9.39±2.24)mg/d]、舍曲林[25～200 mg/d,6周末平均剂量(83.65±25.19) mg/d]治疗6周.疗效采用17项汉密尔顿抑郁量表(HAMD17)和Montgomery-Asberg抑郁量表(MADRS)进行评定,不良反应采用治疗时出现的症状量表(TESS)和实验室检查进行评定.结果 抑郁症首次发病患者初次使用艾司西酞普兰、文拉法辛、度洛西汀、米氮平、瑞波西汀、舍曲林等6种药物治疗,总痊愈率分别为56.00％、64.15％、50.98％、48.08％、40.82％、46.15％,有效率分别为18.00％、18.87％、15.69％、23.08％、18.37％、19.23％,脱落率分别为6.00％、7.55％、9.80％、7.69％、10.20％、3.85％；6组痊愈率和非痊愈率比较,差异无统计学意义(x2=6.87,P=0.23)；6组有效率和无效率比较,差异无统计学意义(x2=9.91,P=0.45)；6组脱落率比较,差异无统计学意义(x2=2.08,P=0.84).其他5组的痊愈率和有效率与舍曲林组比较,差异无统计学意义,但艾司西酞普兰组在治疗2周末的HAMD、MADRS减分率均高于舍曲林组,差异有统计学意义(t=2.08,P=0.04;t=2.18,P=0.03)；文拉法辛组和度洛西汀组便秘者多于舍曲林组(P=0.03,P=0.03),米氮平组头晕、体质量增加多于舍曲林组,差异有统计学意义(P=0.03;P=0.01),瑞波西汀组不良反应与舍曲林组相似,差异无统计学意义.结论 6种抗抑郁药治疗抑郁症首次发病患者疗效相似,但艾司西酞普兰可能较舍曲林2周疗效好,起效更快；6种抗抑郁药总不良反应相似,但文拉法辛组和度洛西汀组便秘者多于舍曲林组,米氮平组头晕、体质量增加多于舍曲林组.
    목적 탐토6충상용항억욱약치료억욱증수차발병환자적료효화불량반응.방법 장307례부합억욱증수차발병환자수궤분위6조,분별사용애사서태보란[제량5～20 mg/d,6주말평균제량(12.74±4.17)mg/d]、문랍법신[75～225 mg/d,6주말평균제량(144.75±39.81) mg/d]、도락서정(고정제량60md)、미담평[7.5～45.0 mg/d,6주말평균제량(28.94±8.92)mg/d]、서파서정[4～12 mg/d,6주말평균제량(9.39±2.24)mg/d]、사곡림[25～200 mg/d,6주말평균제량(83.65±25.19) mg/d]치료6주.료효채용17항한밀이돈억욱량표(HAMD17)화Montgomery-Asberg억욱량표(MADRS)진행평정,불량반응채용치료시출현적증상량표(TESS)화실험실검사진행평정.결과 억욱증수차발병환자초차사용애사서태보란、문랍법신、도락서정、미담평、서파서정、사곡림등6충약물치료,총전유솔분별위56.00％、64.15％、50.98％、48.08％、40.82％、46.15％,유효솔분별위18.00％、18.87％、15.69％、23.08％、18.37％、19.23％,탈락솔분별위6.00％、7.55％、9.80％、7.69％、10.20％、3.85％；6조전유솔화비전유솔비교,차이무통계학의의(x2=6.87,P=0.23)；6조유효솔화무효솔비교,차이무통계학의의(x2=9.91,P=0.45)；6조탈락솔비교,차이무통계학의의(x2=2.08,P=0.84).기타5조적전유솔화유효솔여사곡림조비교,차이무통계학의의,단애사서태보란조재치료2주말적HAMD、MADRS감분솔균고우사곡림조,차이유통계학의의(t=2.08,P=0.04;t=2.18,P=0.03)；문랍법신조화도락서정조편비자다우사곡림조(P=0.03,P=0.03),미담평조두훈、체질량증가다우사곡림조,차이유통계학의의(P=0.03;P=0.01),서파서정조불량반응여사곡림조상사,차이무통계학의의.결론 6충항억욱약치료억욱증수차발병환자료효상사,단애사서태보란가능교사곡림2주료효호,기효경쾌；6충항억욱약총불량반응상사,단문랍법신조화도락서정조편비자다우사곡림조,미담평조두훈、체질량증가다우사곡림조.
    Objective To explore the efficacy and adverse reactions of the 6 kinds of antidepressants for patients with first-episode depression.Methods Three hundred and seven patients,who met the criteria of first-episode major depressive disorder,were randomly assigned into 6 groups and treated by escitalopram [5-20 mg/d,the mean dosage at 6th weekend was (12.74±4.17 )mg/d],venlafaxine [ 75-225 mg/d,the mean dosage at 6th weekend was (114.75±39.81) mg/d ],duloxetine ( with the fixed dosage 60 mg/d),mirtazapine [ 7.5-45.0 mg/d,the mean dosage at 6th weekend was (28.94±8.92)mg/d],reboxetine [4-12 mg/d,the mean dosage at 6th weekend was (9.39±2.24)mg/d] and sertraline [25-200 mg/d,the mean dosage at 6th weekend was (83.65±25.19)mg/d] respectively for 6 weeks.The Hamilton Depressive Scale (HAMD17) and Montgomery-Asberg depressive Scale (MADRS)were adopted to assess efficacy,and adverse reactions were evaluated with Treatment Emergent Symptom Scale and laboratory tests.Results After the 6-week treatment with escitalopram,venlafaxine,duloxetine,mirtazapine,reboxetine,or sertraline,the remission rates were 56.00％,64.15％,50.98％,48.08％,40.82％ and 46.15％ respectively,and response rates were 18.00％,18.87％,15.69％,23.08％,18.37％ and 19.23％,while the drop-out rates were 6.00％,7.55％,9.80％,7.69％,10.20％ and 3.85％ respectively.The total remission rates and non-remission rates among the 6 groups were not significantly different (x2=6.87,P=0.23),and so did between response rate and nonresponse rate(x2=9.91,P=0.45).There was no statistical difference among the six treatment groups as for the drop-out rates (x2=2.08,P=0.84).There were no significant differences in remission rates and response rates between sertraline group and other 5 groups.But the reducing rates of HAMD and MADRS in escitalopram group were significantly greater than that in sertraline group at the end of the second week (t=2.08,P=0.04 ; t=2.18,P=0.03).Compared with sertraline group,incidence rates of constipation in venlafaxine group and duloxetine group were significantly greater ( P=0.03,P=0.03 respectively ).There were significant difference in dizziness and weight gain between mirtazapine group and sertraline group (P=0.03,P=0.01 respectively).Between sertraline group and reboxetine group,there were no significant differences in the incidence rates of adverse reactions.Conclusion The efficacy of the six different kinds of antidepressants prescribed for the first-episode depression is similar.But escitalopram may have a more rapid onset of action and a better efficacy than sertraline in the second week.The total adverse reactions rates of the 6 drugs are similar,but patients are more likely to have constipation with venlafaxeine and duloxetine,and have dizziness and weight gain with mirtazapine than sertraline.
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