Dunner D L, Cohn J B, Walshe T, Cohn C K, Feighner J P, Fieve R R, Halikas J P, Hartford J T, Hearst E D, Settle E C
University of Washington, Seattle 98105.
J Clin Psychiatry. 1992 Feb;53 Suppl:57-60.
Depressive illness among the elderly is an important public health concern. However, treatment of the elderly may be complicated by age-related changes in physiology, general medical status, and susceptibility to side effects. There is therefore a need for improved treatment modalities for depressed elderly patients. Paroxetine is an antidepressant that acts through selective inhibition of serotonin reuptake. It lacks the anticholinergic and cardiovascular side effects of most first- and second-generation antidepressants. The authors present the combined data from two similarly designed comparisons of paroxetine and doxepin in outpatients over 60 years of age with major depression. The results show that paroxetine was an effective as doxepin in alleviating depression as measured on the Hamilton Rating Scale for Depression (HAM-D) total score, the Montgomery and Asberg Depression Rating Scale (MADRS), and the Hopkins Symptom Checklist (SCL) depression factor score. Paroxetine was significantly superior to doxepin on the Clinical Global Impressions (CGI) scale for severity of illness, the HAM-D retardation factor, and the HAM-D depressed mood item. Doxepin produced significantly more anticholinergic effects, sedation, and confusion. Paroxetine was associated with more reports of nausea and headache. These results suggest that paroxetine may be a valuable tool for the treatment of major depression in the elderly.
老年期抑郁症是一个重要的公共卫生问题。然而，老年人的治疗可能会因生理、一般医疗状况以及副作用易感性方面与年龄相关的变化而变得复杂。因此，需要改进针对老年抑郁症患者的治疗方式。帕罗西汀是一种通过选择性抑制5-羟色胺再摄取而起作用的抗抑郁药。它没有大多数第一代和第二代抗抑郁药的抗胆碱能及心血管副作用。作者呈现了两项针对60岁以上患有重度抑郁症的门诊患者进行的帕罗西汀与多塞平的类似设计比较的综合数据。结果显示，在汉密尔顿抑郁量表（HAM-D）总分、蒙哥马利-艾斯伯格抑郁量表（MADRS）以及霍普金斯症状清单（SCL）抑郁因子评分方面，帕罗西汀在缓解抑郁方面与多塞平效果相当。在临床总体印象量表（CGI）的病情严重程度、HAM-D迟缓因子以及HAM-D抑郁情绪项目上，帕罗西汀显著优于多塞平。多塞平产生的抗胆碱能效应、镇静作用及意识模糊更为明显。帕罗西汀引发恶心和头痛的报告更多。这些结果表明，帕罗西汀可能是治疗老年重度抑郁症的一种有价值的药物。
