Longitudinal effects of nortriptyline on EEG sleep and the likelihood of recurrence in elderly depressed patients
Longitudinal effects of nortriptyline on EEG sleep and the likelihood of recurrence in elderly depressed patients
复制标题
DOI：
10.1016/0893-133x(95)00114-s
复制
发表时间：
1996-04-01
影响因子：
7.6
通讯作者：
Frank, E
中科院分区：
文献类型：
--
作者：
Buysse, DJ;Reynolds, CF;Frank, E
我们的目的是确定的影响，去甲替林和安慰剂对主观和EEG睡眠措施超过1年的老年抑郁症患者的维持治疗，并确定这种影响的关系，复发去甲替林或安慰剂治疗的患者在维持therapeutic.EEG和主观睡眠评估进行之前和期间的维持治疗研究的患者患有抑郁症。在急性治疗期间，所有患者均接受去甲替林加人际心理治疗（IPT）。在维持治疗期间，患者被随机分配到四个单元之一的双盲治疗：去甲替林与IPT;去甲替林与药物诊所（无IPT）;安慰剂与IPT;或安慰剂与药物诊所。在治疗前一个时间点、持续去甲替林/IPT治疗缓解后一个时间点和随机分配至维持治疗后三个时间点进行睡眠评估，研究设置为门诊抑郁症治疗诊所的睡眠实验室，受试者为方便的媒体招募和临床转诊的老年门诊抑郁症患者样本（n=72）。对21名去甲替林和10名安慰剂治疗的患者在1年的维持治疗期间进行了完整的睡眠分析。主要结果的措施是主观和脑电图睡眠措施和复发的主要depresson.Our研究结果表明，去甲替林急性和持续减少REM睡眠，增加阶段性REM活动，减少睡眠呼吸暂停，并没有影响周期性肢体运动在睡眠中。在早期持续治疗期间，去甲替林维持治疗的复发与较低的阶段性REM活动相关，但EEG睡眠测量并不能预测安慰剂维持治疗期间的复发。去甲替林治疗的患者复发率低于安慰剂治疗的患者。无论去甲替林治疗与否，主观睡眠质量和维持性IPT均与较低的复发率相关。似乎去甲替林对老年抑郁症患者的REM睡眠和睡眠呼吸暂停有持续影响。去甲替林维持治疗、IPT维持治疗、良好的主观睡眠质量和高相REM活动与维持治疗期间抑郁复发的可能性降低相关。
Our objectives were to determine the effects of nortriptyline and placebo on subjective and EEG sleep measures over 1 year of maintenance therapy in elderly depressed patients and to determine the relationship of such effects to recurrence in nortriptyline or placebo-treated patients during maintenance therapy.EEG and subjective sleep assessments were conducted before and during a maintenance therapy study of patients suffering from major depression. During acute treatment all patients received nortriptyline plus interpersonal psychotherapy (IPT). During maintenance treatment patients were randomly assigned to double-blind treatment in one of four cells: nortriptyline with IPT; nortriptyline with medication clinic (no IPT); placebo with IPT; or placebo with medication clinic. Sleep evaluations were conducted at one point before treatment, one point following remission during continuation nortriptyline/IPT treatment, and at three time points after random assignment to maintenance treatment.The setting was the sleep laboratory of the outpatient depression treatment clinic, and subjects were a convenience sample of media-recruited and clinically referred elderly outpatient depressed patients (n=72). Complete sleep analyses were conducted for 21 nortriptyline-and 10 placebo-treated patients throughout 1 year of maintenance treatment. The main outcome measures were subjective and EEG sleep measures and the recurrence of major depression.Our results show that nortriptyline acutely and persistently decreased REM sleep, increased phasic REM activity, decreased sleep apnea, and had no effect on periodic limb movements during sleep. Recurrence on maintenance nortriptyline was associated with lower phasic REM activity during early continuation therapy, but EEG sleep measures did not predict recurrence during placebo maintenance therapy. Patients treated with nortriptyline had a lower recurrence rate than those treated with placebo. Better subjective sleep quality and maintenance IPT were associated with a lower rate of recurrence regardless of nortriptyline treatment. It seems that nortriptyline has persistent effects on REM sleep and sleep apnea in elderly depressed patients. Maintenance nortriptyline, maintenance IPT, good subjective sleep quality, and high-phasic REM activity are associated with a reduced likelihood of the recurrence of depression during maintenance therapy.