Fatemi S H, Emamian E S, Kist D A
Department of Psychiatry, School of Medicine, University of Minnesota, Minneapolis 55455, USA.
Ann Pharmacother. 1999 Jun;33(6):701-3. doi: 10.1345/aph.18249.
To report the therapeutic efficacy of venlafaxine and bupropion in a patient with treatment-refractory major depression.
A 21-year-old white woman with chronic and recurrent major depression presented with lack of response to several antidepressants. On examination, the patient exhibited neurovegetative signs of depression, guilt feelings, and suicidal ideation. The patient was administered venlafaxine 75 mg three times daily. The dose was titrated to 150 mg three times daily over the next month. Later bupropion was instituted up to 100 mg three times daily over a four-month period. The patient responded favorably to combination therapy and has remained free of depression for approximately 23 months.
Venlafaxine and bupropion are antidepressant agents with unique pharmacologic profiles, each effective in the treatment of depression. Recent data indicate that combinations of selective serotonin-reuptake inhibitors and bupropion can convert partial response to full response in patients with treatment-resistant depression. We considered whether a combination of venlafaxine and bupropion would reduce the depressive symptoms of a patient who was unresponsive to various classes of psychotropic agents. Gradual administration of venlafaxine and bupropion acted synergistically to significantly reduce depressive symptoms (p < 0.002) and significantly increase social function (p < 0.002) over a period of eight months.
To our knowledge this is the first report of successful combination therapy with venlafaxine and bupropion in treatment of chronic recurrent and refractory major depression.
报告文拉法辛和安非他酮治疗难治性重度抑郁症患者的疗效。
一名21岁的白人女性，患有慢性复发性重度抑郁症，对多种抗抑郁药均无反应。检查时，患者表现出抑郁的神经植物性体征、内疚感和自杀意念。给予患者文拉法辛75毫克，每日三次。在下一个月内，剂量滴定至每日三次，每次150毫克。后来在四个月的时间里给予安非他酮，剂量增至每日三次，每次100毫克。患者对联合治疗反应良好，至今约23个月未再抑郁。
文拉法辛和安非他酮是具有独特药理学特征的抗抑郁药，各自对抑郁症治疗有效。最近的数据表明，选择性5-羟色胺再摄取抑制剂与安非他酮联合使用，可使难治性抑郁症患者的部分反应转变为完全反应。我们思考文拉法辛和安非他酮联合使用是否会减轻对各类精神药物均无反应的患者的抑郁症状。在八个月的时间里，逐渐给予文拉法辛和安非他酮产生协同作用，显著减轻抑郁症状（p < 0.002），并显著提高社交功能（p < 0.002）。
据我们所知，这是文拉法辛和安非他酮联合治疗慢性复发性难治性重度抑郁症成功的首例报告。
