摘要
背景:重度抑郁症是抑郁症的一种亚型,单用抗抑郁剂治疗效果差,国外有关研究显示氟西汀合用非典型抗精神病药,可能是有效的治疗策略。目的:观察奥氮平合用氟西汀治疗重度抑郁症的疗效及起效时间。设计:对门诊初诊患者进行完全随机抽样,采用开放性临床试验的观察对比研究。单位:一所军医大学医院临床心理咨询门诊。对象:病例为2004-01/2004-08在本院临床心理咨询门诊就诊的140例患者。纳入标准:符合中国精神障碍与诊断标准第3版(CCMD-3)抑郁症的诊断标准,首诊时17项汉密顿抑郁量表评分总分(HAMD)≥28分,年龄≥18岁。排除标准:①轻-中度抑郁症HAMD(17项≤27分);②继发性抑郁症;③精神分裂症恢复期及其他精神病性情感障碍;④存在严重或不稳定状态的躯体疾病,包括肝、肾、心血管、呼吸、胃肠道、内分泌、神经系统、免疫系统或血液系统疾病等;⑤药物及酒精依赖者⑥妊娠期及哺乳期妇女。符合纳入标准110例,其中男40例,女70例;病程4个月～5年;年龄18～63岁,平均(37±12)岁;均自愿参加本试验。按入院日期单、双日将患者分为单日阿普唑仑组55例,男21例,女34例;双日奥氮平组55例,男19例,女36例。方法:按单日、双日将患者分为2组。单日为阿普唑仑组,阿普唑仑每日中午及睡前0.4mg,氟西汀每日早饭后20mg顿服;双日为奥?
BACKGROUND:Major depression is a subtype of depression. Application of thymoleptics alone has bad effect.It has shown from relevant studies abroad that application of fluoxetine combined with atypical antipsychotic drugs maybe an effective treating strategy. OBJECTIVE:To observe the curative effects of fluoxetine combined with olanzapine and the time of its taking effect. DESIGN:Comparative study of open clinical test with completely random sampling for the first visit outpatients SETTING:A psychological consulting clinic in a hospital of a Military Medical College of Chinese PLA. PARTICIPANTS:Totally 140 patients visiting psychological counseling outpatient clinic in the hospital were collected from January 2004 to August 2004.Inclusion criteria:According to the diagnostic criterion of depression of CCMD-3,patients with total scores of 17 items in Hamilton depression rating scale ≥28 and age ≥18 years old.Exclusion criteria:①slight to middle degree of depression (HAMD ≤27);②secondary depression;③convalescent period of schizophrenia and other affective disorder caused by psychosis;④severe or unstable body diseases,including diseases of liver,kidney, cardiac vessel,respiration,gastro-intestine,endocrine,nervous system,immune system or hematological system,etc.⑤drug or alcohol addict;⑥women in pregnancy and lactation.Totally 110 patients accorded with the inclusive criteria.Among them,there were 40 males and 70 females with the course of disease for 4 months to 5 years, aged 18 to 63 with the average(37±12) years old.They all took part in the trial voluntarily.According to the date of admittance, they were divided into odd-numbered date alprazolam group in which there were 55 patients with 21 males and 34 females and double date olanzapine group in which there were 55 patients with 19 males and 36 females. METHODS:The patients were divided into 2 groups according to the date of admittance.Odd-numbered date group was alprazolam group. 0.4 mg alprazolam was given every noon and before sleep and 20 mg fluoxetine was given at a draught after breakfast every day.Even-numbered date group was olanzapine group. 2.5 mg olanzapine was given before sleep every day and 20 mg fluoxetine was given at a draught after breakfast every day.The course of treatment was 6 weeks.HAMD and HAMA scores of taken were evaluated respectively before and at the end of 1st,2nd,4th and 6th week.Reducing score rate was used to decide effective time.Lost rate was presented as percentage.And improvement of sleep factor and somatization factor in HAMD were observed before therapy and at every observing time period after therapy. MAIN OUTCOME MEASURES:Terminus index:Comparison of HAMD,HAMA score in the two groups before therapy and at the 1st,2nd,4th and 6th weekend after therapy.Scores of sleep factor and anxiety somatization factor of HAMD at every observing time period in the two groups.Substitution index:lost rate in the two groups. Reducing score rate at every observing time period in the two groups. RESULTS:Lost rate in olanzapine group was significantly lower than that in alprazolam group(P< 0.05) and the effect was taken at 1 week after therapy(excellence rate 67%).But,scores of HAMD and HAMA at every observing time period in olanzapine group were significant lower than those in alprazolam group(P< 0.01) and sleep factor and somatization factor at every observing time period improved more significantly than those of alprazolam group(P< 0.01). CONCLUSION:Small amount of olanzapine combined with fluoxetine used to treat major depression of the patients can improve sleep and anxiety body symptoms rapidly and then elevate their living quality significantly.
出处
《中国临床康复》
CSCD
北大核心
2005年第8期254-256,共3页
Chinese Journal of Clinical Rehabilitation
