Treatment of imipramine-resistant recurrent depression, III: Efficacy of monoamine oxidase inhibitors.
Treatment of imipramine-resistant recurrent depression, III: Efficacy of monoamine oxidase inhibitors.
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发表时间：
1992
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通讯作者：
M. Thase;Ellen Frank;A. Mallinger;T. Hamer;Dj Kupfer
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作者：
M. Thase;Ellen Frank;A. Mallinger;T. Hamer;Dj Kupfer
背景：单胺氧化酶抑制剂（MAOIs）治疗三环耐药抑郁症的有效性几乎没有得到系统的研究。方法：对三环丙咪嗪（平均最大剂量为260 mg/天）和人际心理治疗持续治疗无效的患者停用丙咪嗪，进行标准化但开放标签的6周试验，使用苯elzine （N = 4； 60 mg/天）或tranyylcypromine （N = 36；平均38.5 mg/天）并继续进行人际心理治疗。结果42例患者中有40例（95%）完成了试验，其中23例（58%）对治疗有反应。在抑郁、逆转的神经植物症状和躯体症状的测量上有高度显著的改善。反应与抑郁症的严重程度（汉密尔顿抑郁量表maoi前评分）、无能性和逆转神经植物特征综合评分的严重程度以及初始丙咪嗪/人际心理治疗期间的低水平改善显著相关。在符合提出的无能性或非典型抑郁症亚型标准的患者中，67%（18/27）的患者有反应（p < 0.05）；77%（17/22）的患者在无能和逆转神经植物特征的综合测量中得分高于平均水平（p < 0.01）。结论：这些发现为MAOIs治疗三环抵抗性抑郁症提供了强有力的证据，特别是在有疲劳、意志抑制、运动迟缓、嗜睡和/或体重增加等特征的患者中。
BACKGROUND The effectiveness of monoamine oxidase inhibitors (MAOIs) in tricyclic resistant depression has received surprisingly little systematic study. METHOD Patients who failed to respond to sustained, adequate treatment with the tricyclic imipramine (mean maximum dosage = 260 mg/day) and interpersonal psychotherapy were withdrawn from imipramine and treated in a standardized, but open-label 6-week trial with either phenelzine (N = 4; 60 mg/day) or tranylcypromine (N = 36; mean = 38.5 mg/day) and continued interpersonal psychotherapy. RESULTS Forty of 42 patients (95%) completed the trial, of whom 23 (58%) responded to treatment. Highly significant improvement was documented on measures of depression, reversed neurovegetative symptoms, and somatic symptoms. Response was significantly correlated with severity of depression (pre-MAOI score on the Hamilton Rating Scale for Depression), severity of a composite score of anergic and reversed neurovegetative features, and low levels of improvement during initial imipramine/interpersonal psychotherapy. Of patients who met criteria for proposed subforms of anergic or atypical depression, 67% (18/27) responded (p less than .05); 77% (17/22) of patients who scored above the mean on the composite measure of anergic and reversed neurovegetative features responded (p less than .01). CONCLUSION These findings provide strong evidence of the utility of MAOIs in tricyclic-resistant depression, especially in patients with features such as fatigue, volitional inhibition, motoric retardation, hypersomnia, and/or weight gain.