An open study of olanzapine and fluoxetine for psychotic major depressive disorder: interim analyses.
An open study of olanzapine and fluoxetine for psychotic major depressive disorder: interim analyses.
复制标题
奥氮平和氟西汀治疗精神病性重度抑郁症的开放研究：中期分析。
DOI：
10.4088/jcp.v63n1212
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发表时间：
2002
期刊：
影响因子：
--
通讯作者：
M. Fava
中科院分区：
文献类型：
--
作者：
J. Matthews;K. Bottonari;L. Polania;D. Mischoulon;C. Dording;R. Irvin;M. Fava
背景
尽管非典型抗精神病药物通常用于治疗精神病性抑郁症，但尚未发表关于其在这种情况下使用的前瞻性研究。本研究的目的是通过中期分析评估非典型抗精神病药奥氮平与选择性血清素再摄取抑制剂抗抑郁药氟西汀联合使用的疗效。
方法
我们招募了 27 名患有 DSM-IV 定义的具有精神病特征的重度抑郁症的患者（17 名女性 [63.0%] 和 10 名男性 [37.0%]；平均 +/- SD 年龄：41.2 +/- 14.7 岁）参加奥氮平 5 至 20 毫克/天，加氟西汀 20 至 80 毫克/天的开放试验。每次就诊时均使用包含 17 项的汉密尔顿抑郁量表以及 DSM-IV Axis I 疾病结构化临床访谈（患者版）的精神病和情绪模块对患者进行评估。我们正在报告前 6 周治疗的结果。
结果
27 名入组患者中有 22 名（81.5%）完成了为期 6 周的开放试验，5 名（18.5%）退出，只有 2 名（7.4%）因副作用退出。在 27 名患者中，74.1% (N = 20) 符合忧郁特征标准，14.8% (N = 4) 仅有妄想，18.5% (N = 5) 仅有幻觉，66.7% (N = 18) 报告有妄想和幻觉。此外，意向治疗组的总体缓解率如下：抑郁缓解率，66.7%（N = 18）；精神病缓解率，59.3%（N = 16）；精神病性抑郁症反应率，55.6%（N = 15）；精神病性抑郁症缓解率为 40.7% (N = 11)。
结论
奥氮平和氟西汀的组合似乎是治疗精神病性抑郁症的一种有前途、安全且有效的治疗方法。需要双盲研究来证实这一印象。
BACKGROUND
Although atypical antipsychotic agents are commonly used in the treatment of psychotic depression, there are no published prospective studies on their use in this condition. The aim of this study was to assess, by interim analyses, the efficacy of the atypical antipsychotic agent olanzapine in combination with the selective serotonin reuptake inhibitor antidepressant agent fluoxetine.
METHOD
We enrolled 27 patients (17 women [63.0%] and 10 men [37.0%]; mean +/- SD age: 41.2 +/- 14.7 years) with DSM-IV-defined major depressive disorder with psychotic features into an open trial of olanzapine, 5 to 20 mg/day, plus fluoxetine, 20 to 80 mg/day. Patients were assessed at each visit with the 17-item Hamilton Rating Scale for Depression and both the psychotic and mood modules of the Structured Clinical Interview for DSM-IV Axis I Disorders, Patient Edition. We are reporting the results of the first 6 weeks of treatment.
RESULTS
Twenty-two (81.5%) of the 27 enrolled patients completed the 6-week open trial, and 5 (18.5%) dropped out, with only 2 (7.4%) dropping out due to side effects. Of the 27 patients, 74.1% (N = 20) met criteria for melancholic features, 14.8% (N = 4) had delusions alone, 18.5% (N = 5) had hallucinations alone, and 66.7% (N = 18) reported both delusions and hallucinations. In addition, the overall rates of response for the intent-to-treat group were as follows: depression response rate, 66.7% (N = 18); psychosis response rate, 59.3% (N = 16); psychotic depression response rate, 55.6% (N = 15); and psychotic depression remission rate, 40.7% (N = 11).
CONCLUSION
The combination of olanzapine and fluoxetine appears to be a promising, safe, and effective treatment for psychotic depression. Double-blind studies are needed to confirm this impression.