Fava Maurizio, Papakostas George I, Petersen Timothy, Mahal Yasmin, Quitkin Frederick, Stewart Jonathan, McGrath Patrick
The Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
Ann Clin Psychiatry. 2003 Mar;15(1):17-22. doi: 10.1023/a:1023224525400.
Up to 50% of patients with major depressive disorder (MDD) fail to respond to an antidepressant trial, with most taking a selective serotonin reuptake inhibitor (SSRI) as an initial treatment. Switching to bupropion, for depressed patients not responding to SSRIs, is a popular strategy among clinicians. This study assesses the efficacy of bupropion SR in the management of MDD resistant to a prospective trial of fluoxetine. Twenty-nine patients with MDD refractory to an 8- to 12-week open-trial of fluoxetine were enrolled in an 8-week open-trial of bupropion SR. Both a completer analysis (n = 20) and a modified intent-to-treat analysis (n = 26) were performed to evaluate bupropion SR response rates. Using a completer analysis, seven patients (35.0%) were classified as responders, five (25.0%) partial responders, and eight (40.0%) nonresponders. A modified intent to treat analysis resulted in nine (34.6%) patients classified as responders, eight (30.8%) partial responders, and nine (34.6%) nonresponders. The overall proportion of remitters was 6/20 (30.0%) using a completer analysis and 6/26 (23.1%) using an MITT analysis. Approximately 60% of patients with MDD resistant to a prospective trial of fluoxetine experienced a full or partial response to bupropion SR. Bupropion SR should be considered as a potential treatment for patients who remain depressed despite treatment with SSRIs
高达50%的重度抑郁症（MDD）患者对抗抑郁药物试验无反应，大多数患者最初接受选择性5-羟色胺再摄取抑制剂（SSRI）治疗。对于对SSRI无反应的抑郁症患者，换用安非他酮是临床医生常用的策略。本研究评估了缓释安非他酮治疗对氟西汀前瞻性试验耐药的MDD的疗效。29例对氟西汀进行8至12周开放试验难治的MDD患者参加了缓释安非他酮8周开放试验。进行了完全分析（n = 20）和改良意向性分析（n = 26）以评估缓释安非他酮的反应率。采用完全分析，7例患者（35.0%）被分类为反应者，5例（25.0%）为部分反应者，8例（40.0%）为无反应者。改良意向性分析结果为9例（34.6%）患者被分类为反应者，8例（30.8%）为部分反应者，9例（34.6%）为无反应者。采用完全分析时缓解者的总体比例为6/20（30.0%），采用意向性分析时为6/26（23.1%）。约60%对氟西汀前瞻性试验耐药的MDD患者对缓释安非他酮有完全或部分反应。对于尽管接受了SSRI治疗仍持续抑郁的患者，应考虑将缓释安非他酮作为一种潜在的治疗方法。
