Gómez Gómez J M, Teixidó Perramón C
Mental Health Center-Fundació Sanitària d'Igualada, Barcelona, Spain.
J Clin Psychiatry. 2000 Apr;61(4):285-9.
We report, after 3 years of work, a case series showing our initial results (efficacy, tolerability, and safety) with the addition of venlafaxine immediate release (IR) to either clomipramine or imipramine in depressed patients who had shown only partial response to maximal doses of one of those tricyclic antidepressants (TCAs) and no further improvement after addition of usual augmentation drugs.
Eleven patients were treated, 10 of them having a recurrent depressive disorder (DSM-IV) and all of them having current major depression (DSM-IV) that in 9 patients was moderate or severe despite intense TCA treatment as well as usual augmentations. Under open and outpatient conditions, we maintained TCA doses, discontinued previous augmentations, and then added venlafaxine IR to a maximum dosage, if necessary, of 150 mg every 12 hours. There was no control group. Response was assessed using the 17-item Hamilton Rating Scale for Depression (HAM-D), DSM-IV criteria, the Clinical Global Impressions-Severity of Illness scale, and persistence of improvements after 6 months. We measured clinical tolerance (using the UKU Side Effect Rating Scale), blood pressure and heart rate, electrocardiogram (ECG), and blood TCA levels after adding venlafaxine IR.
A sustained improvement (> 50% decrease in HAM-D score plus decrease in DSM-IV severity level) appeared in 9 patients, and sustained full remission (DSM-IV criteria plus HAM-D score < 5) in 7. Panic-agoraphobic symptoms improved in the 2 patients suffering from them. There were no dropouts, and tolerability was good. No significant changes in blood pressure and heart rate, ECG, or blood tricyclic levels were found.
Addition of venlafaxine to clomipramine or imipramine could be an effective and safe augmentation strategy in depressive patients with partial response to maximum-dose monotherapy. A consistent replication of these initial findings is strongly needed.
经过3年的研究工作，我们报告了一个病例系列，展示了在仅对最大剂量的一种三环类抗抑郁药（TCA）产生部分反应且在添加常规增效药物后无进一步改善的抑郁症患者中，加用速释文拉法辛（IR）至氯米帕明或丙咪嗪后的初步结果（疗效、耐受性和安全性）。
对11例患者进行治疗，其中10例患有复发性抑郁症（DSM-IV），所有患者目前均患有重度抑郁症（DSM-IV），尽管接受了强化TCA治疗以及常规增效治疗，但9例患者的病情仍为中度或重度。在开放和门诊条件下，我们维持TCA剂量，停用先前的增效药物，然后必要时将速释文拉法辛加至最大剂量，即每12小时150mg。未设对照组。使用17项汉密尔顿抑郁评定量表（HAM-D）、DSM-IV标准、临床总体印象-疾病严重程度量表以及6个月后的持续改善情况来评估疗效。我们在加用速释文拉法辛后测量了临床耐受性（使用UKU副作用评定量表）、血压和心率、心电图（ECG）以及血液中TCA水平。
9例患者出现持续改善（HAM-D评分降低>50%且DSM-IV严重程度级别降低），7例患者实现持续完全缓解（符合DSM-IV标准且HAM-D评分<5）。2例伴有惊恐-场所恐惧症症状的患者症状有所改善。无患者退出研究，耐受性良好。未发现血压、心率、心电图或血液中三环类药物水平有显著变化。
在对最大剂量单药治疗仅产生部分反应的抑郁症患者中，加用文拉法辛至氯米帕明或丙咪嗪可能是一种有效且安全的增效策略。迫切需要对这些初步发现进行一致的重复验证。
