Benkert O, Szegedi A, Kohnen R
Psychiatrische Klinik, Universität Mainz, Germany.
J Clin Psychiatry. 2000 Sep;61(9):656-63. doi: 10.4088/jcp.v61n0911.
The aim was to compare the efficacy and tolerability of mirtazapine with those of paroxetine.
275 outpatients with a diagnosis of major depressive episode (DSM-IV) and a score > or = 18 on the 17-item Hamilton Rating Scale for Depression (HAM-D-17) were randomly assigned to 6 weeks of treatment with mirtazapine (15-45 mg/day) or paroxetine (20-40 mg/day). Efficacy was assessed by the HAM-D-17, Hamilton Rating Scale for Anxiety (HAM-A), and Clinical Global Impressions scales (Severity and Improvement), and analyses were performed on the intent-to-treat sample (127 mirtazapine-treated patients and 123 paroxetine-treated patients).
Mean daily doses were 32.7 mg of mirtazapine and 22.9 mg of paroxetine. Thirty patients in the mirtazapine group and 33 in the paroxetine group dropped out. Both drugs were equally effective in reducing symptoms of depression. At week 1, the mean HAM-D-17 total score was significantly lower in mirtazapine- than paroxetine-treated patients (16.5 vs. 18.8, p = .0032). Similarly, significantly more mirtazapine-treated patients were HAM-D-17 responders (> or = 50% decrease from baseline) at weeks 1 (23.2% vs. 8.9%, p = .002) and 4 (58.3% vs. 44.5%, p = .04). Both treatments were equally effective in reducing anxiety. However, the reduction in mean HAM-A total score was significantly greater with mirtazapine than with paroxetine at week 1 (-5.1 vs. -3.5, p = .0435). Tolerability of both treatments was good, with more nausea, vomiting, tremor, and sweating in the paroxetine group and more weight increase and influenza-like symptoms in the mirtazapine group.
Mirtazapine and paroxetine were equally effective after 6 weeks of therapy and were both well tolerated. A potentially faster onset of overall therapeutic efficacy of mirtazapine was suggested by significant differences between treatments after 1 week of therapy that were due to slightly larger improvements of several core symptoms of depression as well as distinct prevention of treatment-emergent worsening of anxiety and physical components of depression.
目的是比较米氮平与帕罗西汀的疗效和耐受性。
275例诊断为重度抑郁发作（DSM-IV）且17项汉密尔顿抑郁量表（HAM-D-17）评分≥18分的门诊患者被随机分配接受为期6周的米氮平（15 - 45毫克/天）或帕罗西汀（20 - 40毫克/天）治疗。通过HAM-D-17、汉密尔顿焦虑量表（HAM-A）和临床总体印象量表（严重程度和改善情况）评估疗效，并对意向性治疗样本（127例接受米氮平治疗的患者和123例接受帕罗西汀治疗的患者）进行分析。
米氮平的日均剂量为32.7毫克，帕罗西汀为22.9毫克。米氮平组有30例患者退出，帕罗西汀组有33例患者退出。两种药物在减轻抑郁症状方面同样有效。在第1周时，接受米氮平治疗的患者的HAM-D-17总分显著低于接受帕罗西汀治疗的患者（16.5对18.8，p = 0.0032）。同样，在第1周（23.2%对8.9%，p = 0.002）和第4周（58.3%对44.5%，p = 0.04），接受米氮平治疗的患者中HAM-D-17反应者（较基线下降≥50%）显著更多。两种治疗在减轻焦虑方面同样有效。然而，在第1周时，米氮平组的HAM-A总分下降幅度显著大于帕罗西汀组（-5.1对-3.5，p = 0.0435）。两种治疗的耐受性都良好，帕罗西汀组恶心、呕吐、震颤和出汗更多，米氮平组体重增加和流感样症状更多。
治疗6周后，米氮平和帕罗西汀疗效相当，耐受性均良好。治疗1周后治疗效果存在显著差异，提示米氮平可能起效更快，这是由于其对几种核心抑郁症状的改善略大，以及能明显预防治疗中出现的焦虑加重和抑郁的躯体症状。
