Winokur Andrew, DeMartinis Nicholas A, McNally Daniel P, Gary Ellen M, Cormier Jennifer L, Gary Keith A
Neuropsychopharmacology Treatment, Research, and Training Center, Department of Psychiatry, University of Connecticut Health Center, Talcott Notch Road, Farmington, CT 06030-6415, USA.
J Clin Psychiatry. 2003 Oct;64(10):1224-9. doi: 10.4088/jcp.v64n1013.
Sleep complaints are common in patients with major depressive disorder (MDD). Both MDD and antidepressant drugs characteristically alter objective sleep measures. This study compares the effects of mirtazapine and fluoxetine on sleep continuity measures in DSM-IV MDD patients with insomnia.
Patients (N = 19) received initial baseline polysomnography evaluations over 2 consecutive nights. Subjects were randomly assigned to either fluoxetine (20-40 mg/day) or mirtazapine (15-45 mg/day) treatment for an 8-week, double-blind, double-dummy treatment trial. Single-night polysomnograms were conducted at weeks 1, 2, and 8, with depression ratings assessed at baseline and weeks 1, 2, 3, 4, 6, and 8. Statistical analysis was performed by repeated-measures analysis of variance followed by Dunnet's post hoc analyses.
Patients receiving mirtazapine (N = 8) had significant improvement in objective sleep physiology measures at 8 weeks. Improvements in sleep latency, sleep efficiency, and wake after sleep onset were significant after only 2 weeks of mirtazapine treatment. No significant changes in sleep continuity measures were observed in the fluoxetine group (N = 11). Both groups improved clinically in mood and subjective sleep measures from baseline, with no differences between groups.
These data demonstrate the differential effects of mirtazapine and fluoxetine, with significant improvement in favor of mirtazapine, on objective sleep parameters in MDD patients with insomnia.
睡眠问题在重度抑郁症（MDD）患者中很常见。MDD和抗抑郁药物都有改变客观睡眠指标的特点。本研究比较了米氮平和氟西汀对符合《精神疾病诊断与统计手册》第四版（DSM-IV）标准且伴有失眠的MDD患者睡眠连续性指标的影响。
19名患者连续两晚接受初始基线多导睡眠图评估。受试者被随机分配至氟西汀（20 - 40毫克/天）或米氮平（15 - 45毫克/天）治疗组，进行为期8周的双盲、双模拟治疗试验。在第1、2和8周进行单晚多导睡眠图检查，并在基线及第1、2、3、4、6和8周评估抑郁评分。采用重复测量方差分析及Dunnet事后分析进行统计分析。
接受米氮平治疗的患者（N = 8）在8周时客观睡眠生理指标有显著改善。米氮平治疗仅2周后，睡眠潜伏期、睡眠效率和睡眠后觉醒时间就有显著改善。氟西汀组（N = 11）的睡眠连续性指标未观察到显著变化。两组在情绪和主观睡眠指标上均较基线有临床改善，组间无差异。
这些数据表明，米氮平和氟西汀对伴有失眠的MDD患者的客观睡眠参数有不同影响，米氮平有显著改善作用。
