Nortriptyline versus fluoxetine in the treatment of depression and in short-term recovery after stroke: A placebo-controlled, double-blind study
Nortriptyline versus fluoxetine in the treatment of depression and in short-term recovery after stroke: A placebo-controlled, double-blind study
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DOI：
10.1176/appi.ajp.157.3.351
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发表时间：
2000-03-01
影响因子：
17.7
通讯作者：
Starkstein, SE
中科院分区：
文献类型：
--
作者：
Robinson, RG;Schultz, SK;Starkstein, SE
目的：该研究比较了去甲替林和氟西汀与安慰剂治疗抑郁症以及从中风后的身体和认知障碍中恢复的情况。方法：1991年至1997年期间，共有104例急性卒中患者入组了一项双盲随机研究，比较了去甲替林、氟西汀和安慰剂治疗12周的效果。大多数患者是从爱荷华州得梅因的一家康复医院招募的，但也使用了其他招募地点。抑郁症和非抑郁症患者都被招募，以确定是否改善恢复可以介导的机制无关抑郁症。在12周内给予去甲替林25 mg/天逐渐增加至100 mg/天或氟西汀10 mg/天逐渐增加至40 mg/天或相同的安慰剂。个体患者对抑郁症治疗的反应定义为汉密尔顿抑郁量表评分下降超过50%，不再符合重度或轻度抑郁症的诊断标准。治疗组的恢复改善定义为与安慰剂治疗的患者相比，从基线到治疗试验结束，在日常生活活动和认知和社会功能水平的损害方面的平均评分显著更高。结果如下：去甲替林在治疗卒中后抑郁、改善焦虑症状和改善日常生活活动恢复（通过功能独立性测量）方面的反应显著高于氟西汀或安慰剂。去甲替林或氟西汀对抑郁症或非抑郁症患者的认知或社会功能恢复没有影响。氟西汀以10-40 mg/天的剂量增加，在12周的治疗中平均体重减轻15.1磅（初始体重的8%），这在去甲替林或安慰剂中没有观察到。结论：考虑到本研究中使用的药物剂量，去甲替林治疗卒中后抑郁症的疗效优于氟西汀，其疗效优于氟西汀上级。要证明抗抑郁药治疗对卒中恢复的益处，可能需要确定特定的患者亚组、替代测量量表或最佳治疗时间。
Objective: This study compared nortriptyline and fluoxetine with placebo in the treatment of depression and in recovery from physical and cognitive impairments after stroke. Method: A total of 104 patients with acute stroke enrolled between 1991 and 1997 entered a double-blind randomized study comparing nortriptyline, fluoxetine, and placebo over 12 weeks of treatment. The majority of patients were recruited from a rehabilitation hospital in Des Moines, Iowa, but other enrollment sites were also used. Both depressed and nondepressed patients were enrolled to determine whether improved recovery could be mediated by mechanisms unrelated to depression. Nortriptyline in doses of 25 mg/day gradually increased to 100 mg/day or fluoxetine in doses of 10 mg/day gradually increased to 40 mg/day or identical placebo were given over 12 weeks. Response to treatment of depression for individual patients was defined as a greater-than-50% reduction in scores on the Hamilton Rating Scale for Depression and no longer fulfilling diagnostic criteria for major or minor depression. Improved recovery for a treatment group was defined as a significantly higher mean score from baseline to end of the treatment trial, compared with patients treated with placebo, on measures of impairment in activities of daily living and levels of cognitive and social functioning. Results: Nortriptyline produced a significantly higher response rare than fluoxetine or placebo in treating poststroke depression, in improving anxiety symptoms, and in improving recovery of activities of daily living as measured by the Functional Independence Measure. There was no effect of nortriptyline or fluoxetine on recovery of cognitive or social functioning among depressed or nondepressed patients. Fluoxetine in increasing doses of 10-40 mg/day led to an average weight loss of 15.1 pounds (8% of initial body weight) over 12 weeks of treatment that was not seen with nortriptyline or placebo. Conclusions: Given the doses of medication used in this study, nortriptyline was superior to fluoxetine in the treatment of poststroke depression. Demonstrating a benefit of antidepressant treatment in recovery from stroke may require the identification of specific subgroups of patients, alternative measurement scales, or the optimal time of treatment.