DeBattista Charles, Solvason H Brent, Poirier Jennifer, Kendrick Ellen, Schatzberg Alan F
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine Stanford, CA 94305-5723, USA.
J Clin Psychopharmacol. 2003 Feb;23(1):27-30. doi: 10.1097/00004714-200302000-00005.
Many patients fail to achieve an adequate response to a given antidepressant trial. The best-studied augmentation agents, lithium and thyroid supplementation are less commonly used. Augmenting antidepressants with bupropion has become an increasingly common strategy in the treatment of resistant depression. Several case reports and 2 open label studies suggest efficacy of this strategy. The purpose of this study is to further examine the utility of bupropion sustained release (SR) augmentation in patients with inadequate response to selective serotonin reuptake inhibitors. Patients who met DSM-IV criteria for major depression and had failed to achieve adequate response to an SSRI were considered for this study. Eligible patients were required to have a score of 16 on the 24-item Hamilton Depression Rating Scale (HDRS). Patients were treated openly for 6 weeks with bupropion SR added to their existing antidepressant. The dose range of bupropion was 150 to 300 mg per day. At each visit, patients were assessed using the Beck Depression Inventory (BDI), the Hamilton Depression Ratings Scale (HDRS), and the Clinical Global Impression (CGI). Twenty-eight patients (12 men, 16 women) entered the study. Twenty-five patients completed the six-week trial. With respect to the clinical benefit of bupropion SR augmentation, 15 out of 28, or 54% of patients, were classified as responders, showing a decrease in their HDRS or BDI scores of 50% or more between baseline and Week 6. This prospective, open-label trial supports the use of bupropion SR in the augmentation of SSRIs and venlafaxine. Placebo controlled trials should be completed to further evaluate the efficacy of this strategy.
许多患者在接受特定的抗抑郁药物试验时未能获得充分的疗效。研究得最为充分的增效剂，如锂盐和甲状腺补充剂，使用得较少。用安非他酮增强抗抑郁药的疗效已成为治疗难治性抑郁症越来越常用的策略。一些病例报告和两项开放标签研究表明了该策略的有效性。本研究的目的是进一步检验安非他酮缓释剂（SR）增效在对选择性5-羟色胺再摄取抑制剂反应不佳的患者中的效用。符合《精神疾病诊断与统计手册》第四版（DSM-IV）重度抑郁症标准且对选择性5-羟色胺再摄取抑制剂未能获得充分疗效的患者被纳入本研究。符合条件的患者在24项汉密尔顿抑郁量表（HDRS）上的得分须为16分。患者在其现有的抗抑郁药基础上加用安非他酮缓释剂进行为期6周的开放治疗。安非他酮的剂量范围为每天150至300毫克。每次就诊时，使用贝克抑郁量表（BDI）、汉密尔顿抑郁量表（HDRS）和临床总体印象量表（CGI）对患者进行评估。28名患者（12名男性，16名女性）进入研究。25名患者完成了为期6周的试验。关于安非他酮缓释剂增效的临床益处，28名患者中有15名（54%）被归类为有反应者，其汉密尔顿抑郁量表或贝克抑郁量表得分在基线至第6周期间下降了50%或更多。这项前瞻性、开放标签试验支持安非他酮缓释剂用于增强选择性5-羟色胺再摄取抑制剂和文拉法辛的疗效。应完成安慰剂对照试验以进一步评估该策略的疗效。
