Efficacy and Tolerability of High-Dose Escitalopram in Posttraumatic Stress Disorder.
Efficacy and Tolerability of High-Dose Escitalopram in Posttraumatic Stress Disorder.
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DOI：
10.1097/jcp.0000000000000626
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发表时间：
2017-03
影响因子：
2.9
通讯作者：
Shalev A
中科院分区：
文献类型：
--
作者：
Qi W;Gevonden M;Shalev A
开放标签试验表明，艾司西酞普兰（高达20 mg/d）是一种有效的治疗一些，但不是所有的创伤后应激障碍（PTSD）患者。高剂量的艾司西酞普兰有效地减少了对常规剂量无反应的患者的抑郁症状。目前的研究检查了大剂量艾司西酞普兰治疗PTSD的疗效、耐受性和依从性。45名PTSD患者接受了12周逐渐增加剂量的艾司西酞普兰治疗，第四周达到每天40 mg。其中，12名参与者在研究开始时接受常规剂量的抗抑郁药，包括艾司西酞普兰（n=7）。临床医生管理的PTSD量表（CAPS）评估治疗前、3个月（治疗终止时）和6个月（维持效应）时PTSD症状的严重程度。CAPS评分降低20%被认为具有临床意义。在每次临床会议上监测不良事件和药物依从性。线性混合模型分析显示，3个月时平均CAPS评分显著降低（11.5±18.1分），6个月时保持增益（F（2，34.56）= 8.15，p = 0.001）。11名参与者（34.3%）在3个月时表现出临床显著改善。只有9名参与者（20%）离开了研究。没有严重的不良事件，只有少数轻微的不良事件，超过10%的参与者报告了两起（腹泻，11.1%;嗜睡，11.1%）。高剂量的艾司西酞普兰在PTSD患者中是可以耐受的，并且依从性良好。它们在组水平上的有益效果是由于在一个患者子集中的特别好的反应。既往药物治疗的变异性排除了将结果明确归因于高剂量艾司西酞普兰。
Open label trials suggest that escitalopram (up to 20mg/d) is an effective treatment for some, but not all posttraumatic stress disorder (PTSD) patients. Higher doses of escitalopram effectively reduced major depression symptoms in patients who had not responded to regular doses. The current study examines the efficacy, tolerability, and adherence to high-dose escitalopram in PTSD. 45 PTSD patients received 12 weeks of gradually increasing doses of escitalopram reaching 40mg daily at four weeks. Among those, 12 participants received regular doses of antidepressants at study onset including escitalopram (n=7). The Clinician Administered PTSD Scale (CAPS) evaluated PTSD symptoms severity before treatment, at 3 months (upon treatment termination), and at six months (maintenance effect). A 20% reduction in CAPS scores was deemed clinically significant. Adverse events and medication adherence were monitored at each clinical session. Linear mixed models analysis showed a significant reduction of mean CAPS scores (11.5±18.1 points) at 3 months and maintenance of gains by 6 months (F(2, 34.56) = 8.15, p = 0.001). Eleven participants (34.3%) showed clinically significant improvement at 3 months. Only nine participants (20%) left the study. There were no serious adverse events and few mild ones with only two (diarrhea, 11.1%; drowsiness, 11.1%) reported by more than 10% of participants. High doses of escitalopram are tolerable and well adhered to in PTSD. Their beneficial effect at a group level is due to a particularly good response in a subset of patients. Variability in prior pharmacological treatment precludes a definite attribution of the results to high doses of escitalopram.