Tranylcypromine versus imipramine in anergic bipolar depression.
Tranylcypromine versus imipramine in anergic bipolar depression.
复制标题
反苯环丙明与丙咪嗪治疗无反应性双相抑郁症。
DOI：
10.1176/ajp.148.7.910
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发表时间：
1991
期刊：
影响因子：
--
通讯作者：
Houck,P
中科院分区：
文献类型：
--
作者：
Himmelhoch,JM;Thase,ME;Mallinger,AG;Houck,P
目的比较单胺氧化酶抑制剂（MAOI）氨酰环丙氨酸与三环丙咪嗪治疗无能性双相抑郁症的疗效。方法采用对照双盲比较方法对56例符合操作性标准的无能性双相抑郁症门诊患者进行研究。双相I型和II型抑郁症患者在对照组之间分布均匀。结果通过患者评分的贝克抑郁量表和临床评分的汉密尔顿抑郁量表、拉斯金躁狂和抑郁量表、临床总体印象量表和匹兹堡逆转植物症状量表来测量。28例患者用丙氨环丙胺治疗，28例用丙咪嗪治疗。接受研究筛选的双相抑郁症患者中有73%符合无能性抑郁症的标准，这与此前100多年来对双相抑郁症的研究结果一致。结果丙氨酰环丙氨酸在降低损耗、改善症状和提高整体反应方面具有统计学上显著的优势，且治疗后出现轻躁或躁狂症的风险未增加。结论：丙氨酰基丙氨酸治疗双相抑郁症的显著疗效与神经性疼痛和神经植物性症状逆转有关。双相情感障碍I型和双相情感障碍II型患者的结果相当，但双相情感障碍I型患者在治疗过程中出现情绪波动的风险明显更高。尽管丙咪嗪相对较差的表现值得密切关注，但这些发现进一步证明了MAOIs在出现无功、运动迟缓、嗜食和/或嗜睡的患者中的效用。
ObjectiveThis investigation compared the efficacy of the monoamine oxidase inhibitor (MAOI) tranylcypromine with that of the tricyclic imipramine in the treatment of anergic bipolar depressive illness.MethodA controlled, double-blind comparison was used to study 56 outpatients who met operationalized criteria for anergic bipolar depression. Patients with bipolar I and II depression were equally distributed between comparison groups. Outcome was measured by the patient-rated Beck Depression Inventory and the clinician-rated Hamilton Rating Scale for Depression, Raskin Mania and Depression Scales, Clinical Global Impression Scale, and the Pittsburgh Reversed Vegetative Symptom Scale. Twenty-eight patients were treated with tranylcypromine and 28 with imipramine. Seventy-three percent of bipolar depressive patients screened for the study met criteria for anergic depression, consistent with previous findings from studies in bipolar illness that stretch back over 100 years.ResultsTranylcypromine produced statistically significant superior outcome in terms of lower attrition, greater symptomatic improvement, and higher global response without increased risk of treatment-emergent hypomania or mania.ConclusionsThe authors propose that the apparently superior efficacy of tranylcypromine in bipolar depression is specifically linked to anergia and reversed neurovegetative symptoms. Bipolar I and bipolar II patients had comparable outcomes, but bipolar I patients had a significantly greater risk of treatment-emergent mood swings. Although the relatively poor showing of imipramine warrants close scrutiny, these findings provide further documentation of the utility of MAOIs in patients presenting with anergia, motor retardation, hyperphagia, and/or hypersomnia.