Bruijn J A, Moleman P, Mulder P G, van den Broek W W
Department of Psychiatry, "Dijkzigt" University Hospital, Rotterdam, The Netherlands.
Pharmacopsychiatry. 1999 May;32(3):87-92. doi: 10.1055/s-2007-979200.
Tricyclic antidepressants and more recent antidepressants are generally considered to have equivalent efficacy in the treatment of depression. After a previous report of a marked difference in the response to mirtazapine compared to imipramine, we report here an analysis of different symptom clusters. One hundred seven consecutive in-patients with major depression (Diagnostic and Statistical Manual III-R, DSM-III-R) and a Hamilton Rating Scale for Depression (HRS-D) score of 18 points or more were randomly assigned to double-blind treatment. Two and four weeks after predefined blood levels had been obtained, the severity of depression was assessed using the HRS-D. The mean dosages used were 235 mg/day of imipramine and 77 mg/day of mirtazapine, the latter being in excess of the 15-45 mg/day range currently advised. Total HRS-D scores and seven symptom clusters were analyzed in the 85 patients (79%) who were not receiving any co-medication. Imipramine was more effective against the clusters related to core symptoms of depression: "depression and guilt", "retardation", and "melancholia", respectively. Mirtazapine showed a biphasic response with regard to the clusters "sleep" and "anxiety/agitation", respectively, which consisted of a marked response after two weeks of predefined blood level, but with a waning of this effect at four weeks. Imipramine produced a more gradual response on these clusters, which was more pronounced at four weeks than with mirtazapine. Two aspects of the present study could be related to this finding: blood level control resulted in optimal treatment with imipramine but not mirtazapine, and - most importantly - the patients were not receiving any anxiolytic or hypnotic co-medication. These findings suggest that mirtazapine may have anxiolytic and sedative properties and fewer antidepressant properties than imipramine in severely depressed in-patients.
三环类抗抑郁药和更新的抗抑郁药在治疗抑郁症方面通常被认为具有同等疗效。在之前有报告称米氮平与丙咪嗪的反应存在显著差异之后，我们在此报告对不同症状群的分析。107例连续住院的重度抑郁症患者（依据《精神疾病诊断与统计手册第三版修订本》，DSM - III - R），汉密尔顿抑郁量表（HRS - D）评分达18分及以上，被随机分配接受双盲治疗。在达到预定血药浓度后的两周和四周，使用HRS - D评估抑郁严重程度。所用平均剂量分别为丙咪嗪235毫克/天和米氮平77毫克/天，后者超出了目前建议的15 - 45毫克/天范围。对85例（79%）未接受任何联合用药的患者的HRS - D总分和七个症状群进行了分析。丙咪嗪分别对与抑郁症核心症状相关的症状群“抑郁与内疚”“迟缓”和“忧郁症”更有效。米氮平在“睡眠”和“焦虑/激动”症状群方面分别呈现双相反应，即在达到预定血药浓度两周后有显著反应，但在四周时这种效果减弱。丙咪嗪对这些症状群产生的反应更为渐进，在四周时比米氮平更明显。本研究的两个方面可能与这一发现有关：血药浓度控制使丙咪嗪达到了最佳治疗效果，但米氮平未达到，而且——最重要的是——患者未接受任何抗焦虑或催眠联合用药。这些发现表明，在重度抑郁的住院患者中，米氮平可能具有抗焦虑和镇静特性，但其抗抑郁特性比丙咪嗪少。
