Combination of Antidepressant Medications From Treatment Initiation for Major Depressive Disorder: A Double-Blind Randomized Study
Combination of Antidepressant Medications From Treatment Initiation for Major Depressive Disorder: A Double-Blind Randomized Study
复制标题
DOI：
10.1176/appi.ajp.2009.09020186
复制
发表时间：
2010-03-01
影响因子：
17.7
通讯作者：
Bergeron, Richard
中科院分区：
文献类型：
--
作者：
Blier, Pierre;Ward, Herbert E.;Bergeron, Richard
目的：各种类型的抗抑郁药物通常仅在约三分之一的患者中诱导重度抑郁症的缓解。在先前一项使用米氮平或帕罗西汀单药或从治疗开始联合使用的研究中，6周内缓解的患者比例是使用任一药物单药患者的两倍。在这项双盲研究中，作者试图从治疗开始就为抗抑郁药物的不同组合的优越性提供证据。方法：符合DSM-IV重度抑郁症标准的患者（N=105）从治疗开始随机分配接受氟西汀单药治疗（20 mg/天）或米氮平（30 mg/天）联合氟西汀（20 mg/天）、文拉法辛（225 mg/天，14天内滴定）或安非他酮（150 mg/天）治疗6周。主要结果是汉密尔顿抑郁量表（HAM-D）score.Results：总脱落率为15%，没有显着差异，四组。与氟西汀单药治疗相比，所有三个联合治疗组在HAM-D方面的改善均显著更大。氟西汀组的缓解率（定义为HAM-D评分≤ 7分）为25%，米氮平+氟西汀组为52%，米氮平+文拉法辛组为58%，米氮平+安非他酮组为46%。在有明显反应的患者中，双盲中止一种药物产生复发的cases.Conclusions约40%：氟西汀单药治疗的联合治疗耐受性良好，更临床有效。研究结果增加了越来越多的证据，表明从治疗开始使用抗抑郁药组合与使用单一药物相比，缓解的可能性可能会增加一倍。
Objective: Various classes of antidepressant medications generally induce remission of major depressive disorder in only about one-third of patients. In a previous study using mirtazapine or paroxetine alone or in combination from treatment initiation, the rate of patients who remitted within a 6-week period was twice that of patients using either drug alone. In this double-blind study, the authors sought to produce evidence for the superiority of different combinations of antidepressant drugs from treatment initiation.Method: Patients (N=105) meeting DSM-IV criteria for major depressive disorder were randomly assigned to receive, from treatment initiation, either fluoxetine monotherapy (20 mg/day) or mirtazapine (30 mg/day) in combination with fluoxetine (20 mg/day), venlafaxine (225 mg/day titrated in 14 days), or bupropion (150 mg/day) for 6 weeks. The primary outcome measure was the Hamilton Depression Rating Scale (HAM-D) score.Results: The overall dropout rate was 15%, without notable differences among the four groups. Compared with fluoxetine monotherapy, all three combination groups had significantly greater improvements on the HAM-D. Remission rates (defined as a HAM-D score of 7 or less) were 25% for fluoxetine, 52% for mirtazapine plus fluoxetine, 58% for mirtazapine plus venlafaxine, and 46% for mirtazapine plus bupropion. Among patients who had a marked response, double-blind discontinuation of one agent produced a relapse in about 40% of cases.Conclusions: The combination treatments were as well tolerated as fluoxetine monotherapy and more clinically effective. The study results, which add to a growing body of evidence, suggest that use of antidepressant combinations from treatment initiation may double the likelihood of remission compared with use of a single medication.