Isaac Maria B, Isaac Michael T
South London and Maudsley NHS Trust, Gresham Psychiatric Intensive Care Unit, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, UK.
Hum Psychopharmacol. 2003 Oct;18(7):569-74. doi: 10.1002/hup.522.
Evidence that pindolol accelerates the action of antidepressants has been contradictory, and it is not clear why. The present study analyses the relationship between plasma prolactin (PRL) and ACTH levels and changes in relation to a milnacipran and pindolol combination versus milnacipran plus placebo.
Eighty depressed patients agreed to take part in a double-blind randomized trial of milnacipran plus pindolol or placebo. Fifty-eight of them agreed to also take measures of ACTH and PRL levels. ACTH and PRL plasma levels were estimated on days 0 and 42 of the 6-week study. Age, gender and time of blood collection were recorded for each individual. The Montgomery-Asberg depression rating scale (MADRS) was used to measure the response to treatment. The patients were grouped into those with higher versus lower basal ACTH levels using the median of the sample (25 ng/l).
There were statistical differences in MADRS scores between the treatment groups on day 42. There were correlations between PRL levels on days 0 and 42; age and PRL levels on day 0; time of the PRL sample and the PRL levels on day 0 and day 42; ACTH and PRL levels on day 42. Regression analysis of the 58 patients showed that on day 0, PRL levels were dependent on the ACTH plasma levels on day 0, the time of the collection of the blood sample and the age. On day 42, the PRL levels were dependent on the ACTH levels and the time of the blood collection but not on the age. Patients with lower baseline ACTH levels on day 0 displayed a better clinical outcome when taking the combination of milnacipran and pindolol as shown in the differences in MADRS on day 42. The same group of patients showed lower PRL levels on day 42.
ACTH plasma levels at baseline or screening may help to predict the response to antidepressant treatment.
关于吲哚洛尔加速抗抑郁药作用的证据相互矛盾，原因尚不明确。本研究分析了血浆催乳素（PRL）和促肾上腺皮质激素（ACTH）水平之间的关系，以及与米那普明和吲哚洛尔联合用药与米那普明加安慰剂相比的变化情况。
80名抑郁症患者同意参与米那普明加吲哚洛尔或安慰剂的双盲随机试验。其中58人还同意测量ACTH和PRL水平。在为期6周的研究的第0天和第42天估计ACTH和PRL血浆水平。记录每个个体的年龄、性别和采血时间。使用蒙哥马利-阿斯伯格抑郁评定量表（MADRS）来衡量治疗反应。根据样本中位数（25 ng/l）将患者分为基础ACTH水平较高和较低的两组。
第42天时治疗组之间的MADRS评分存在统计学差异。第0天和第42天的PRL水平之间存在相关性；第0天的年龄和PRL水平之间存在相关性；PRL样本采集时间与第0天和第42天的PRL水平之间存在相关性；第42天的ACTH和PRL水平之间存在相关性。对58名患者的回归分析表明，在第0天，PRL水平取决于第0天的ACTH血浆水平、血样采集时间和年龄。在第42天，PRL水平取决于ACTH水平和采血时间，而不取决于年龄。如第42天MADRS的差异所示，第0天基础ACTH水平较低的患者在服用米那普明和吲哚洛尔联合用药时显示出更好的临床结果。同一组患者在第42天显示出较低的PRL水平。
基线或筛查时的ACTH血浆水平可能有助于预测对抗抑郁治疗的反应。
