Treatment of depression and menopause-related symptoms with the serotonin-norepinephrine reuptake inhibitor duloxetine
Treatment of depression and menopause-related symptoms with the serotonin-norepinephrine reuptake inhibitor duloxetine
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DOI：
10.4088/jcp.v68n0619
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发表时间：
2007-06-01
影响因子：
5.3
通讯作者：
Cohen, Lee S.
中科院分区：
文献类型：
--
作者：
Joffe, Hadine;Soares, Claudio N.;Cohen, Lee S.
背景资料：患有抑郁症的绝经后妇女经常同时出现潮热（血管痉挛症状）、睡眠障碍、焦虑和疼痛症状。针对所有这些症状的治疗策略尚未调查到data.Method：研究参与者绝经后妇女，40至60岁，重度抑郁症（DSM-IV标准）和血管痉挛症状。研究设计包括一项为期2周的单盲安慰剂导入期，随后是一项为期8周的开放标签灵活给药（60-120 mg/天）的度洛西汀研究，用于安慰剂治疗无效的女性。主要结局指标为度洛沙汀治疗8周期间蒙哥马利-艾斯伯格抑郁量表（MADRS）评分的变化。次要结局指标包括血管痉挛症状、睡眠质量、焦虑和疼痛的变化。使用非参数方法进行分析。患者于2005年5月31日至2006年5月22日入组研究。结果：在30名符合条件的女性中，20名开始接受开放标签度洛沙坦治疗。其中14名（70.0%）女性完成了研究。治疗8周后，MADRS评分在统计学上显著降低（p <0.001），评分从19.0（四分位距[IQR] = 15.0-21.0）降至5.5（IQR = 3.0-9.0）。血管痉挛症状（p = 0.003）、焦虑（p = 0.002）、睡眠质量（p <0.001）和疼痛（p <0.05）也有统计学意义的改善。结论：在开放标签度洛塞汀治疗8周后，患有抑郁症和血管痉挛症状的绝经后妇女在抑郁症、血管痉挛症状、睡眠、焦虑和疼痛方面有显著改善。鉴于绝经后女性中这些症状的常见并发症，度洛沙汀可能为患有抑郁症和绝经相关症状的绝经后女性提供重要的治疗获益。
Background: Postmenopausal women with depression frequently have co-occurring symptoms of hot flashes (vasomotor symptoms), sleep disturbance, anxiety, and pain. Treatment strategies that target all of these symptoms together have not been investigated to date.Method: Study participants were postmenopausal women, 40 to 60 years old, with major depressive disorder (DSM-IV criteria) and vasomotor symptoms. The study design included a 2-week, single-blind placebo run-in phase followed by an 8-week open-label flexible-dosing (60-120 mg per day) study of duloxetine for women who did not respond to placebo. The primary outcome measure was change in Montgomery-Asberg Depression Rating Scale (MADRS) score during 8 weeks of duloxetine therapy. Secondary outcome measures included changes in vasomotor symptoms, sleep quality, anxiety, and pain. Analyses were conducted using non-parametric methods. Patients were enrolled in the study from May 31, 2005, through May 22, 2006.Results: Of 30 women eligible to participate in this study, 20 initiated treatment with open-label duloxetine. Fourteen (70.0%) of these women completed the study. There was a statistically significant decrease in MADRS scores after 8 weeks of treatment (p < .001), with scores declining from 19.0 (interquartile range [IQR] = 15.0-21.0) to 5.5 (IQR = 3.0-9.0). There was also a statistically significant improvement in vasomotor symptoms (p = .003), anxiety (p = .002), sleep quality (p < .001), and pain (p < .05).Conclusions: Postmenopausal women with depression and vasomotor symptoms had significant improvement in depression, vasomotor symptoms, sleep, anxiety, and pain after 8 weeks of open-label duloxetine therapy. Given the common co-occurrence of these symptoms in postmenopausal women, duloxetine may offer important therapeutic benefits for postmenopausal women who have depression and menopause-related symptoms.