抑郁症的用药选择

本文综述了国外抑郁症治疗的用药经验及进展，包括各种新型抗抑郁剂的药理、临床用药特点及效应和药物经济学等。     

抑郁症患者治疗前后血浆皮质醇水平的变化

目的:探讨抑郁症患者治疗前后血浆皮质醇水平的变化。方法:对160例抑郁症患者给予抗抑郁药治疗6周,分别于治疗前及治疗后进行汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评估及血浆皮质醇水平检测。结果:本组治疗前后HAMD总分分别为(24.98±5.10)和(7.57±5.61);HAMA总分分别为(20.62±6.90)和(6.21±5.17);血浆皮质醇水平分别为(407.34±144.29)nmol/L和(354.64±137.13)nmol/L。治疗后HAMD总分、HAMA总分及血浆皮质醇水平较治疗前明显下降(P均<0.001);不同性别间血浆皮质醇水平差异无统计学意义(P>0.05);血浆皮质醇变化值与HAMD、HAMA减分率不相关(r=0.084,r=0.049;P均>0.05)。结论:抗抑郁药物治疗可显著降低抑郁症患者血浆皮质醇水平。     

血管性抑郁症的临床特征及治疗

本介绍血管性抑郁症的概况、临床特征及治疗原则,强调临床医生应重视这组特殊抑郁症。     

老年期抑郁症的药物治疗选择

本文结合抗抑郁药在老年人体内分布改变的生理基础及老年期抑郁症临床特点，对选用抗抑郁药的注意事项给以讨论。     

“知情同意”用于抑郁症孕妇的抗抑郁治疗

针对患抑郁症的孕妇妊娠期抗抑郁治疗中如何运用知情同意及需要完善的一些问题进行了综述。以探讨抑郁症孕妇治疗中如何密切医患关系，减少医患过程中法律纠纷的发生。     

现代电休克治疗在老年抑郁症中的应用

目的：了解现代电休克治疗(MECT)在老年抑郁症的临床应用情况。方法：对象为1999年1月—2001年9月间的住院老年患者(≥60岁)，符合CCMD—2—R抑郁症诊断标准，共131例，合并应用MECT为研究组(71例)，未合并MECT为对照组(60例)，按自行设计的调查表对两组病历资料进行回顾性分析。结果：MECT组病情较对照组显著较重，但住院天数显著较少。结论：MECT能缩短老年抑郁症患者的住院病程。     

博乐欣治疗焦虑症和抑郁症的临床疗效分析

采用博乐欣 (venlafaxine)对 2 3例焦虑症和 2 5例抑郁症进行 6周的开放性治疗。现将其疗效报道于后。1　对象与方法1 1　对象　系 2 0 0 0年 10月～ 2 0 0 2年 10月在我院住院或门诊治疗的病人 4 8例。入组标准为符合CCMD - 2 -R诊断标准的 2 3例焦虑症和 2 5例抑郁症。焦虑症     

抑郁症的药物治疗进展

抑郁症是一个重要的公共卫生问题,抗抑郁药物目前有了突飞猛进的进展.本文主要按照单胺假说、氨基酸和肽类假说、下丘脑-垂体-肾上腺(HPA)轴功能异常假说、细胞因子学说等,对抑郁症的药物治疗进展进行综述.     

奎硫平辅助治疗抑郁症的临床疗效及安全性研究

目的探讨奎硫平合并抗抑郁药治疗抑郁症的疗效及安全性。方法将60名抑郁症患者随机分为合并奎硫平治疗组和对照组，合并奎硫平治疗组在原抗抑郁药物治疗的基础上合并使用奎硫平，对照组继续使用原抗抑郁药物，疗程为4周。入组时及入组第1、2、3、4周末对患者进行汉密顿抑郁量表（HAMD-17）、汉密顿焦虑量表（HAMA）、副反应量表（TESS）评定。结果合并奎硫平组共完成25例，1例在加用50mg奎硫平后出现双下肢水肿，故退出研究。1例在治疗过程中出现严重精神病性症状，在治疗第1周由研究者中止研究。2例在第2周脱落，1例在第四周时脱落。治疗第1周末起两组HAMD、HAMA总分差异有统计学意义（P〈0．01），合并奎硫平组低于对照组。研究组总有效率为83．3％，痊愈与显效占56．7％，对照组分别为50％和20％。研究组与对照组疗效存在显著差异。研究组出现不良反应共13例（43．3％），1例因服用50mg奎硫平后出现双下肢水肿而退出研究，其余均为可疑或极轻到中度。对照组共12例（40％）出现不良反应。结论奎硫平合并抗抑郁药治疗抑郁症是1种有效且相对安全的治疗方法。     

Heat-shock protein-70 genes and response to antidepressants in major depression

In the search of predictors of antidepressant efficacy, much interest has recently focused on pro-inflammatory proteins, as they were found to be elevated during major depressives states and decreased by antidepressant drugs. In the present paper we investigated the role of the genes coding for heat-shock-70 family proteins, recently hypothesized to be activated by antidepressants and thus mediate the reduction of pro-inflammatory cytosines. One hundred and forty two hospitalised patients, affected by major depression and treated with antidepressants drugs for a major depressive episode were evaluated for depressive severity at the baseline and at the discharge and genotyped for five SNPs within the genes HSPA1L, HSPA1A and HSPA1B. Markers were not individually associated with symptom severity after treatment. Instead, we found a three markers haplotype, including SNPs within HSPA1L and HSPA1A, associated with a poorer response to antidepressant treatment (p=0.005). Single markers as well as haplotypes were not associated with other clinical features. In conclusion, genetic variants within the genes coding for HSP-70 family proteins may affect the action of antidepressants and thus their therapeutic efficacy.     

Recurrent brief depression: A frequent syndrome in clinical practice

Recurrent brief depression (RBD) is not a new artificial group of depression syndromes, but an important, frequently overlooked and clearly identified subcategory of depressive disorders. The symptoms do not differ from major depression; however, the duration of the brief episodes usually lasts 1 &#45 3 days. The patient can suffer from both brief and longer manifestations of depression and therefore qualify for both diagnoses: major depression on the one hand/or RBD on the other. If the patient suffers from both conditions the case is more severe, with higher social impairment and higher suicidal risk. Epidemiological studies carried out in different parts of the world indicated a prevalence rate of RBD of between 5% and 10% of patients seeking help in general practice. Unfortunately there is no clear treatment as yet established for RBD, although about 50% of these patients are given psychotropic drugs by practitioners. Controlled trials with antidepressants did not show a beneficial effect and there is no hint in the literature as to whether psychological therapies might be helpful. There is a need for further treatment studies in this important form of depression, which is categorizable within the depressive spectrum. ( Int J Psych Clin Pract 2000; 4: 195-199)     

抗抑郁药物治疗儿童青少年抑郁症的临床试验进展

本文目的是归纳并总结新型抗抑郁药物治疗儿童青少年抑郁症的效果和安全性,为儿童青少年抑郁症的药物干预提供参考。抑郁症是儿童青少年常见的精神疾病之一,严重影响患者的健康成长,可造成自杀等严重不良后果。使用抗抑郁药物是治疗儿童青少年抑郁症的重要手段,然而可用于儿童青少年的抗抑郁药物种类较少,临床应用受到一定限制。本文就近十年抗抑郁药物治疗儿童青少年抑郁症的临床试验进展进行综述。     

老年抑郁症的临床现象学特征

目的：探讨老年抑郁症的临床现象学特征。方法：按中国精神障碍分类与诊断标准第3版心境障碍抑郁发作诊断标准，收集33例60岁以上首次发作的患者(老年组)，30例18—50岁首次发作的患者(青壮年组)进行对照研究。结果：老年组焦虑、激越、疑病、记忆减退、胃肠症状和伴发躯体疾病明显多于青壮年组，焦虑程度较青壮年组严重。老年组近期疗效比青壮年组差。结论：老年抑郁症症状特征及预后各方面均有自身的特点。     

Changes in the cannabinoids receptors in rats following treatment with antidepressants

The endocannabinoid (eCB) system plays a significant role in the pathophysiology of depression. The potential participation of this system in the mechanism of action of antidepressants has been highlighted in recent years. The aim of this study was to investigate the expression of cannabinoid (CB) receptors using Western blot and CB₁ receptor density using autoradiography after acute or chronic administration of antidepressant drugs [imipramine (IMI, 15 mg/kg), escitalopram (ESC, 10 mg/kg) and tianeptine (TIA, 10 mg/kg)]. Antidepressants given chronically elevated CB₁ receptor density in the cortical structures and hippocampal areas, while a decrease of CB₁ receptor density was observed in the striatum after IMI and ESC treatment. The CB₁ receptor expression decreases in the dorsal striatum after chronic administration of IMI and ESC or the receptor rise in the hippocampus after chronic ESC and TIA treatment were confirmed using Western blot analyses. An increase in the CB₂ receptor expression was observed in the cortical structures and hippocampus after chronic administration of ESC and TIA, while a decrease in this expression was noted in the striatum and cerebellum after chronic IMI treatment. Our results provide clear evidence that the antidepressant exposures provoke some modulations within the eCB system through CB receptors.     

躯体化障碍与抑郁症的临床特征比较

目的：弄清躯体化障碍是否为一处陷匿形式的抑郁症。方法：按ＤＳＭ－Ⅳ诊断标准收集躯体化障碍５６例（Ａ组）、抑郁症５１例（Ｂ组）,对两级人列均用病史问卷及汉尔顿抑郁量表（ＨＡＭＤ）进行调查评定。结果：Ａ组躯体症状频率显著高于Ｂ组,抑郁症状频率和ＨＡＮＤ总分显著低于Ｂ组,两组在ＨＡＭＤ因子分析,疾病行为与态度、病程演变及发病背景方面存在显著差异。     

Evaluation of treatment response in depression studies using a Bayesian parametric cure rate model

Efficacy trials with antidepressant drugs often fail to show significant treatment effect even though efficacious treatments are investigated. This failure can, amongst other factors, be attributed to the lack of sensitivity of the statistical method as well as of the endpoints to pharmacological activity. For regulatory purposes the most widely used efficacy endpoint is still the mean change in HAM-D score at the end of the study, despite evidence from literature showing that the HAM-D scale might not be a sensitive tool to assess drug effect and that changes from baseline at the end of treatment may not reflect the extent of response. In the current study, we evaluate the prospect of applying a Bayesian parametric cure rate model (CRM) to analyse antidepressant effect in efficacy trials with paroxetine. The model is based on a survival approach, which allows for a fraction of surviving patients indefinitely after completion of treatment. Data was extracted from GlaxoSmithKline's clinical databases. Response was defined as a 50% change from baseline HAM-D at any assessment time after start of therapy. Survival times were described by a log-normal distribution and drug effect was parameterised as a covariate on the fraction of non-responders. The model was able to fit the data from different studies accurately and results show that response to treatment does not lag for two weeks, as is mythically believed. In conclusion, we demonstrate how parameterisation of a survival model can be used to characterise treatment response in depression trials. The method contrasts with the long-established snapshot on changes from baseline, as it incorporates the time course of response throughout treatment.