Meoni Paolo, Hackett David, Lader Malcolm
Wyeth Research, Paris, France.
Depress Anxiety. 2004;19(2):127-32. doi: 10.1002/da.10141.
We evaluated the relative efficacy of venlafaxine XR on the psychic versus somatic symptoms of anxiety in patients with generalized anxiety disorder as determined by the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Data were pooled and analyzed from 1,841 patients with generalized anxiety disorder who participated in five short-term (8-week) double-blind, multicenter, placebo-controlled studies, two of which had long-term (6-month) extensions. Somatic and psychic anxieties were studied using the Hamilton rating scale for anxiety (HAM-A) factor scores. We examined response rates (> or =50% improvement over baseline severity score) in the overall population and in patients with mainly somatic symptomatology at baseline (somatizers). Venlafaxine XR significantly reduced factor scores for both psychic and somatic HAM-A factors compared with placebo, from the first and second weeks of treatment, respectively. Patients treated with venlafaxine XR had significantly higher rates of response than patients receiving placebo on the psychic (58% vs. 38%, P<.001 at week 8; 66% vs. 35% at week 24, P<.001) and somatic (56% vs. 43%, P<.001 at week 8; 67% vs. 47% at week 24, P<.001) factors of the HAM-A. There was a TreatmentxFactor interaction (P<.027) in response rates: Patients treated with venlafaxine showed similar somatic and psychic anxiety response rates, whereas placebo-treated patients showed higher somatic compared with psychic response rates. Somatizers showed similar rates of response to the total population for the somatic factor of the HAM-A in either treatment group. Patients with generalized anxiety disorder treated with venlafaxine XR showed similar absolute rates of response on somatic and psychic symptoms, but relative to patients treated with placebo, more improvement in psychic than somatic symptoms.
我们依据《精神疾病诊断与统计手册》第4版，评估了文拉法辛缓释剂对广泛性焦虑症患者焦虑的精神症状与躯体症状的相对疗效。汇总并分析了1841例广泛性焦虑症患者的数据，这些患者参与了5项短期（8周）双盲、多中心、安慰剂对照研究，其中2项研究有长期（6个月）的延长期。使用汉密尔顿焦虑量表（HAM-A）因子评分来研究躯体焦虑和精神焦虑。我们检查了总体人群以及基线时主要有躯体症状的患者（躯体化者）的缓解率（相对于基线严重程度评分改善≥50%）。与安慰剂相比，文拉法辛缓释剂分别从治疗的第1周和第2周起，显著降低了HAM-A精神和躯体因子的评分。接受文拉法辛缓释剂治疗的患者在HAM-A的精神（第8周时58%对38%，P<0.001；第24周时66%对35%，P<0.001）和躯体（第8周时56%对43%，P<0.001；第24周时67%对47%，P<0.001）因子上的缓解率显著高于接受安慰剂治疗的患者。缓解率存在治疗×因子交互作用（P<0.027）：接受文拉法辛治疗的患者表现出相似的躯体和精神焦虑缓解率，而接受安慰剂治疗的患者躯体缓解率高于精神缓解率。在任一治疗组中，躯体化者在HAM-A躯体因子上的缓解率与总体人群相似。接受文拉法辛缓释剂治疗的广泛性焦虑症患者在躯体和精神症状上的绝对缓解率相似，但相对于接受安慰剂治疗的患者，精神症状的改善比躯体症状更多。
