Bupropion for Depression in Schizophrenia
Bupropion for Depression in Schizophrenia
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DOI：
10.1097/wnf.0b013e3181f5a5f9
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发表时间：
2010-09-01
影响因子：
1
通讯作者：
Zink, Mathias
中科院分区：
文献类型：
--
作者：
Englisch, Susanne;Inta, Dragos;Zink, Mathias
目的：抑郁症的儿茶酚胺能理论假设多巴胺和去甲肾上腺素的神经传递功能障碍。因此，抗抑郁药安非他酮，一种双多巴胺和去甲肾上腺素再摄取抑制剂，可能也是重度抑郁发作的精神分裂症患者的一种有价值的治疗选择。然而，关于抑郁症患者诱发精神病症状的报告质疑其在精神病谱系终身诊断患者中的应用。在这里，我们报告了安非他酮在精神分裂症患者中的抗抑郁疗效、安全性和耐受性的治疗经验。方法：我们报道了一系列连续的精神病谱系终身诊断的抑郁症患者，这些患者在服用稳定剂量的抗精神病药物的同时接受了6周的安非他酮延长释放治疗（N = 5）。采用心理测量量表《阳性和阴性综合征量表》、《阴性症状评定量表》、《精神分裂症卡尔加里抑郁量表》、《汉密尔顿抑郁量表》和《锥体外系症状量表》。结果：所有患者的重度抑郁发作均有显著改善。精神病阳性症状仍然稳定地消失，而阴性症状和整体精神病理都有显著改善。这种治疗通常耐受性良好；然而，观察到轻微的脑电图恶化。结论：本病例提示，如果提供稳定的抗精神病药物和脑电图监测，安非他酮对精神分裂症患者的抗抑郁治疗是安全有效的。进一步的随机对照研究是必要的。
Objectives: The catecholaminergic theory of depression assumes dysfunctional neurotransmission of dopamine and norepinephrine. Therefore, the antidepressant bupropion, a dual dopamine and norepinephrine reuptake inhibitor, might be a valuable treatment option also in schizophrenic patients with major depressive episodes. However, reports on induced psychotic symptoms in depressed patients questioned its use in patients with psychotic spectrum lifetime diagnoses. Here, we report on treatment experiences with bupropion in patients with schizophrenia with respect to antidepressive efficacy, safety, and tolerability.Methods: We report on a consecutive series of depressed patients with psychotic spectrum lifetime diagnoses who received bupropion extended release for a period of 6 weeks in addition to stable doses of antipsychotic agents ( N = 5). The psychometric scales Positive and Negative Syndrome Scale, Scale for the Assessment of Negative Symptoms, Calgary Depression Scale for Schizophrenia, Hamilton Depression Scale, and Extrapyramidal Symptoms Scale were applied.Results: All patients experienced significant improvements of their major depressive episodes. Psychotic positive symptoms remained stably absent, whereas both negative symptoms and global psychopathology considerably improved. The treatment was generally well tolerated; however, subtle electroencephalographic deteriorations were observed.Conclusions: This case series suggests safe and effective antidepressive treatment with bupropion in patients with schizophrenic disorders, if stable antipsychotic medication and electroencephalographic-monitoring are provided. Further randomized studies involving a control group are necessary.