Augmentation with olanzapine in TCA‐refractory depression with melancholic features: a consecutive case series
Augmentation with olanzapine in TCA‐refractory depression with melancholic features: a consecutive case series
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奥氮平强化治疗具有忧郁特征的 TCA 难治性抑郁症：连续病例系列
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发表时间：
2008
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通讯作者：
J. Ishigooka
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作者：
Hitoshi Takahashi;M. Kamata;Keizo Yoshida;H. Higuchi;J. Ishigooka
采用为期8周的开放标签研究设计，我们报告了奥氮平对三环类抗抑郁药阿米替林反应不足的抑郁症住院患者的强化策略的效果。研究对象为符合DSM-IV严重抑郁障碍标准的住院患者，这些患者在接受阿米替林治疗后仍有残留症状。进入研究后，奥氮平加入阿米替林，并根据患者的临床情况调整剂量。使用意向处理方法对数据进行分析，并继续进行最后的观察。采用配对t检验对数据从基线到终点进行评估。在参加这项研究的26名患者中，23名患者完成了试验，3名患者退出了试验。奥氮平平均剂量6.5(SD = 2.4)mg/d。在本研究期间，蒙哥马利-阿斯伯格抑郁量表(MADRS)的平均得分从33.6分(SD = 3.5分)降至20.8分(SD = 9.1分)(较基线下降37.9%)(p <； 0.001)。10名患者(38.5%)被视为有反应(MADRS评分较基线下降50%或更多)。这些结果表明，奥氮平对TCAs抵抗型抑郁症可能是有效的和耐受性良好的。我们不能从开放的、非对照的临床试验中得出任何确定的结论。需要进行双盲对照试验来确认这一初步发现。版权所有©2008 John Wiley&Sons，Ltd.
Using an 8‐week, open label study design, we report the effect of augmentation strategy with olanzapine in hospitalized depressive patients with melancholic features who had insufficient response to a tricyclic antidepressant (TCA), amitriptyline. Subjects were hospitalized patients meeting the criteria of DSM‐IV major depressive disorder with melancholic features who had been suffering from residual symptoms after treatment of amitriptyline. After study entry, olanzapine was added to amitriptyline and the dose was adjusted according to patients' clinical condition. Data were analyzed using an intent‐to‐treat methodology, with last observation carried forward. Paired t‐test was adopted to assess the data from baseline to endpoint. Of 26 patients who enrolled in this study, 23 patients completed the trial and 3 patients dropped out. The mean dose of olanzapine was 6.5 (SD = 2.4) mg/day. The mean score of Montgomery–Asberg Depression Rating Scale (MADRS) was significantly decreased from 33.6 (SD = 3.5) to 20.8 (SD = 9.1) during this study (37.9% from baseline) (p < 0.001). Ten patients (38.5%) were considered as responders (50% or greater reduction in MADRS scores from baseline). These results suggest that augmentation with olanzapine in TCAs‐resistant melancholia may be effective and well tolerated. We cannot draw any conclusion with certainty from the open‐label, uncontrolled clinical trial. Double blind, controlled trial is needed to confirm this preliminary finding. Copyright © 2008 John Wiley & Sons, Ltd.