Lam Raymond W, Hossie Helen, Solomons Kevin, Yatham Lakshmi N
Division of Clinical Neuroscience, Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1 Canada.
J Clin Psychiatry. 2004 Mar;65(3):337-40.
There are limited data comparing medication strategies in patients with treatment-resistant depression. In this study, we compared the effects of combining citalopram and bupropion-SR versus switching to the other monotherapy in treatment-resistant depression.
This was a naturalistic, open-label cohort study. Patients with DSM-IV major depressive disorder who had not responded to at least 1 previous antidepressant and at least 6 weeks of treatment with citalopram or bupropion-SR were treated in a standard clinical protocol. In alternate months, eligible consecutive patients were treated by adding citalopram or bupropion-SR, or by switching to the other medication. Patients were assessed at baseline and after 6 weeks of treatment with the 29-item version of the Structured Interview Guide for the Hamilton Depression Rating Scale, Seasonal Affective Disorders Version (SIGH-SAD).
A total of 61 patients completed the study: 32 in the combination condition and 29 in the monotherapy switch condition. The combination condition was superior to the monotherapy switch in the SIGH-SAD change score (-14.8 vs. -10.1, respectively, p <.04) and the proportion of patients in clinical remission (28% vs. 7%, p <.05). There were no differences in the proportion of patients who had side effects or in the severity of the side effects experienced.
The results of this cohort study suggest that combining citalopram and bupropion-SR is more effective than switching to a monotherapy. Combination treatment was well tolerated with no greater side effect burden than monotherapy. Limitations of this study include the nonrandomized design, open-label treatment, and small sample size.
关于难治性抑郁症患者药物治疗策略比较的数据有限。在本研究中，我们比较了西酞普兰与安非他酮缓释剂联合用药与换用另一种单一疗法治疗难治性抑郁症的效果。
这是一项自然主义的开放标签队列研究。患有DSM-IV重度抑郁症且对至少1种先前的抗抑郁药无反应，并且接受过至少6周西酞普兰或安非他酮缓释剂治疗的患者，按照标准临床方案进行治疗。每隔一个月，符合条件的连续患者接受添加西酞普兰或安非他酮缓释剂治疗，或换用另一种药物治疗。在基线时以及使用汉密尔顿抑郁量表季节性情感障碍版结构化访谈指南29项版本（SIGH-SAD）治疗6周后对患者进行评估。
共有61名患者完成了研究：联合用药组32名，单一疗法换药组29名。联合用药组在SIGH-SAD变化评分（分别为-14.8和-10.1，p<.04）和临床缓解患者比例（28%对7%，p<.05）方面优于单一疗法换药组。出现副作用的患者比例或所经历副作用的严重程度没有差异。
这项队列研究的结果表明，西酞普兰与安非他酮缓释剂联合用药比换用单一疗法更有效。联合治疗耐受性良好，副作用负担不高于单一疗法。本研究的局限性包括非随机设计、开放标签治疗和样本量小。
