换用文拉法辛或度洛西汀对抑郁症残留症状的疗效观察

Outcomes Following a Switch to Duloxetine or Venlafaxine in Treatment of Residual Symptoms of Depressed Patients

关键词:  首发抑郁症  缓解不全  残余症状  文拉法辛  度洛西汀

Key words:  first-episode major depressive disorder  poorly response  residual symptoms  duloxetine  venlafaxine

摘要:

目的 探索文拉法辛或度洛西汀对选择性五羟色胺再摄取抑制剂（selective serotonin reuptake inhibitor，SSRI）类药物抗抑郁疗效不佳抑郁症患者的疗效及安全性。方法 对2015年11月-2016年10月间就诊且SSRI类抗抑郁药疗效不佳或有残余症状的96例首发抑郁症患者，以单纯随机的方式分为2组，经洗脱期后，分别给予可变剂量的文拉法辛或度洛西汀治疗，进行为期12周的前瞻性研究，在基线及第2，4，6，8，12周末评定汉密尔顿抑郁量表（Hamilton Depression Scale，HAMD-17）、汉密尔顿焦虑量表（Hamilton Anxiety Scale，HAMA）、治疗出现的不良反应量表（Treatment Emergent Symptom Scale，TESS）；同时由患者自评快感缺失量表（Snaith-Hamilton Pleasure Scale，SHAPS）、愉快情绪体验量表（Temporal Experience Pleasure Scale，TEPS），分析和评价2组的疗效及安全性。结果 12周末，换用去甲肾上腺素和五羟色胺再摄取抑制剂（serotonin and norepinephrine reuptake inhibitor，SNRI）类药物后，患者总体有效率和治愈率分别为73.96%和39.58%，同治疗前相比，HAMD-17、HAMA、SHAPS、TEPS分值均有较大改善（P<0.05或P<0.01），但文拉法辛组及度洛西汀组间的疗效无统计学差异（P>0.05）。2组的不良反应相似，主要为口干、便秘、乏力、性功能障碍等，但文拉法辛组的血压增高现象略多（P<0.05）。结论 SSRI类药物抗抑郁疗效不佳者，换用SNRI类药物后能有效改善包括快感缺失在内的抑郁症状。文拉法辛和度洛西汀疗效相近，安全性均较好，其中文拉法辛对血压影响较度洛西汀明显，应慎用于高血压患者。

Abstract:

OBJECTIVE To explore the efficacy and safety of switching to duloxetine or venlafaxine in treatment of poorly-response-to-selective serotonin reuptake inhibitor(SSRI) first-episode depressed patients. METHODS The 96 patients with first-episode major depressive disorder(MDD) who had poor efficacy or residual symptoms after treatment with SSRIs were recruited and simply randomized into two groups for a 12-weeks prospective study, they were given variable dose duloxetine or venlafaxine respectively after washout period, and were assessed with the scales of Hamilton Depression Scale (HAMD-17), Hamilton Anxiety Scale(HAMA), Treatment Emergent Symptom Scale(TESS), Snaith-Hamilton Pleasure Scale (SHAPS) and Temporal Experience Pleasure Scale(TEPS) at baseline and 2nd, 4th, 6th, 8th, 12th weekends, the efficacy and safety between the two groups were analyze and evaluate at endpoint. RESULTS Total response rate and remission rate of patients were 73.96% and 39.58% respectively at 12th weekend after switching to serotonin and noradrenaline reuptake inhibitor(SNRI). Scores of HAMD-17, HAMA, SHAPS and TEPS at endpoint were much better than which at baseline(P<0.05 or P<0.01). The efficacy between duloxetine group and venlafaxine group showed no statistical difference (P>0.05), and the by-effects were similar in two groups, mainly including dry mouth, constipation, fatigue, sexual dysfunction and so on, but blood pressure increased higher in venlafaxine group than in duloxetine group(P<0.05). CONCLUSION Depressive symptoms including anhedonia resistant to SSRI could be improved by SNRI effectively. Duloxetine is as effective and safe as venlafaxine, but venlafaxine may increase blood pressure and should be used with caution in patients with hypertension.