Bump G M, Mulsant B H, Pollock B G, Mazumdar S, Begley A E, Dew M A, Reynolds C F
Intervention Research Center for Late-Life Mood Disorders, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Depress Anxiety. 2001;13(1):38-44. doi: 10.1002/1520-6394(2001)13:1<38::aid-da6>3.0.co;2-7.
Elderly depressed patients are vulnerable to recurrence of depression and benefit from long-term antidepressant therapy. Physicians increasingly use selective serotonin re-uptake inhibitors (SSRIs) as maintenance therapy, although in the absence of data showing that SSRIs are as efficacious as tricyclic antidepressants (TCAs) in the prevention of depression relapse and recurrence. Our objective was to evaluate, in an open trial, the efficacy of paroxetine versus nortriptyline for preventing recurrence of depression in the elderly. Elderly patients with major depression were randomly assigned in a double-blinded fashion to receive either paroxetine or nortriptyline for the acute treatment of depression. Patients who did not respond or tolerate their assigned medications were crossed over openly to the comparator agent. Patients whose depression remitted continued antidepressant medication (paroxetine n = 38; nortriptyline n = 21) during an open 18-month follow-up study. We examined the rates of and times to relapse and to termination of treatment for any reason. Paroxetine (PX) and nortriptyline (NT) patients had similar rates of relapse (16% vs. 10%, respectively) and time to relapse (60.3 weeks vs. 58.8 weeks, respectively) over 18 months. A lower burden of residual depressive symptoms and side effects during continuation and maintenance treatment was evident in nortriptyline-treated patients. Paroxetine and nortriptyline demonstrated similar efficacy in relapse and recurrence prevention in elderly depressed patients over an 18-month period.
老年抑郁症患者易患抑郁症复发，长期抗抑郁治疗对其有益。尽管缺乏数据表明选择性5-羟色胺再摄取抑制剂（SSRI）在预防抑郁症复发方面与三环类抗抑郁药（TCA）同样有效，但医生越来越多地使用SSRI作为维持治疗药物。我们的目的是在一项开放性试验中评估帕罗西汀与去甲替林预防老年抑郁症复发的疗效。患有重度抑郁症的老年患者以双盲方式随机分配，接受帕罗西汀或去甲替林进行抑郁症的急性治疗。对所分配药物无反应或不耐受的患者开放交叉接受对照药物治疗。在一项为期18个月的开放性随访研究中，抑郁症缓解的患者继续服用抗抑郁药物（帕罗西汀n = 38；去甲替林n = 21）。我们检查了复发率、复发时间以及因任何原因终止治疗的时间。在18个月的时间里，帕罗西汀（PX）组和去甲替林（NT）组患者的复发率（分别为16%和10%）和复发时间（分别为60.3周和58.8周）相似。接受去甲替林治疗的患者在持续和维持治疗期间残留抑郁症状和副作用的负担较低。在18个月期间，帕罗西汀和去甲替林在预防老年抑郁症患者复发方面显示出相似的疗效。
