Comparison of two-phase treatment with imipramine or fluvoxamine, both followed by lithium addition, in inpatients with major depressive disorder
Comparison of two-phase treatment with imipramine or fluvoxamine, both followed by lithium addition, in inpatients with major depressive disorder
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DOI：
10.1176/appi.ajp.161.11.2060
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发表时间：
2004-11-01
影响因子：
17.7
通讯作者：
Moleman, P
中科院分区：
文献类型：
--
作者：
Birkenhäger, TK;van den Broek, WW;Moleman, P
目的：本研究的目的是比较两个两阶段的药物治疗策略的疗效与DSM-IV的抑郁症住院患者。方法：在第1阶段，患者参加了一个双盲研究丙咪嗪与氟伏沙明的影响，最终评价反应4周后，患者达到目标血浆水平。在第11阶段，对于第1阶段无治疗反应或部分反应的患者，在丙咪嗪或氟伏沙明中加入锂。在患者达到目标血浆锂水平（0.6-1.0 mmol/L）后3周进行最终反应评估。在第1阶段结束时，70例丙咪嗪治疗患者中有16例（23%）和68例氟伏沙明治疗患者中有10例（15%）达到缓解（定义为最终汉密尔顿抑郁评定量表评分：7分）。在第11阶段结束时，70名丙咪嗪治疗的患者中有41名（59%）与68名氟伏沙明治疗的患者中有27名（40%）符合缓解条件，这是有利于丙咪嗪策略的显著差异。两组中只有少数人接受了合并用药。在第一阶段和第二阶段，停药率低（5%和10%，分别）。结论：丙咪嗪与后续锂添加是上级类似的战略与氟伏沙明治疗严重抑郁症住院患者。这两种策略都具有良好的耐受性。
Objective: This study was designed to compare the efficacy of two two-phase pharmacological treatment strategies for inpatients with DSM-IV major depressive disorder.Method: During phase 1, patients participated in a double-blind study of the effects of imipramine versus fluvoxamine, with final evaluation of response 4 weeks after patients attained the target plasma level. In phase 11, for patients without treatment response or with partial response in phase 1, lithium was added to imipramine or fluvoxamine. Final evaluation of response was made 3 weeks after the patients attained the target plasma level of lithium (0.6-1.0 mmol/liter).Results: One hundred thirty-eight patients were enrolled in the study. At the end of phase 1, remission, defined as a final Hamilton Depression Rating Scale score : 7, was achieved by 16 (23%) of 70 imipramine-treated patients and 10 (15%) of 68 fluvoxamine-treated patients. At the end of phase 11, 41 (59%) of 70 imipramine-treated patients versus 27 (40%) of 68 fluvoxamine-treated patients qualified for remission, a significant difference in favor of the imipramine strategy. Only a small minority of both groups received concomitant medication. In both phase I and phase II, the discontinuation rate was low (5% and 10%, respectively).Conclusions: Imipramine with subsequent lithium addition is superior to a similar strategy with fluvoxamine for treatment of severely depressed inpatients. Both strategies were well tolerated.