Nelson J C, Kennedy J S, Pollock B G, Laghrissi-Thode F, Narayan M, Nobler M S, Robin D W, Gergel I, McCafferty J, Roose S
Department of Psychiatry, Yale University School of Medicine, New Haven 06504, CT, USA.
Am J Psychiatry. 1999 Jul;156(7):1024-8. doi: 10.1176/ajp.156.7.1024.
This study compared the efficacy, tolerability, and safety of paroxetine and nortriptyline in depressed patients with ischemic heart disease.
After a 2-week, single-blind placebo lead-in phase, 81 outpatients with DSM-III-R-defined nonpsychotic unipolar major depression and ischemic heart disease were randomly assigned to double-blind treatment with paroxetine or nortriptyline for 6 weeks. Paroxetine was administered at a fixed-flexible dose of 20-30 mg/day. Nortriptyline dose was adjusted with the use of blood-level monitoring to reach a plasma concentration of 50-150 ng/ml.
Twenty-seven of the 41 patients who started treatment with paroxetine and 29 of the 40 patients who started treatment with nortriptyline had an improvement of at least 50% in their Hamilton Depression Rating Scale scores. Significantly more patients taking nortriptyline discontinued treatment prematurely (35% versus 10%), and more patients taking nortriptyline had adverse events resulting in termination (25% versus 5%).
Both treatments were efficacious. Sixty-three percent of all patients improved at least 50%, and of these, 90% met the criteria for remission. Paroxetine was better tolerated than nortriptyline and less likely to produce cardiovascular side effects.
本研究比较了帕罗西汀和去甲替林对患有缺血性心脏病的抑郁症患者的疗效、耐受性和安全性。
在为期2周的单盲安慰剂导入期后，81例患有DSM-III-R定义的非精神病性单相重度抑郁症和缺血性心脏病的门诊患者被随机分配接受帕罗西汀或去甲替林双盲治疗6周。帕罗西汀以20 - 30毫克/天的固定灵活剂量给药。去甲替林剂量通过血药浓度监测进行调整，以达到血浆浓度50 - 150纳克/毫升。
开始使用帕罗西汀治疗的41例患者中有27例，开始使用去甲替林治疗的40例患者中有29例，其汉密尔顿抑郁量表评分改善至少50%。服用去甲替林的患者中，过早停药的患者明显更多（35%对10%），因不良事件导致停药的去甲替林服用者也更多（25%对5%）。
两种治疗方法均有效。所有患者中有63%改善至少50%，其中90%达到缓解标准。帕罗西汀的耐受性优于去甲替林，产生心血管副作用的可能性较小。
