Rampello Liborio, Alvano Alessandro, Chiechio Santina, Malaguarnera Mariano, Raffaele Rocco, Vecchio Ignazio, Nicoletti Francesco
Department of Neurosciences, University of Catania, Catania, Italy.
Neuropsychobiology. 2004;50(4):322-8. doi: 10.1159/000080960.
Antidepressants are used to treat chronic daily headache disorders such as migraine and chronic tension-type headache (TTH), which are often associated with depression and anxiety. Here, we studied the efficacy and tolerability of amitriptyline and citalopram, given alone or in combination, in patients with 'triple' comorbidity of depression, TTH, and migraine. Eighty-eight patients were enrolled in the study and randomly divided into two groups. The first group received amitriptyline and the second citalopram for 16 weeks. Patients were assessed at weeks 0, 4, 8, and 16. The two drugs were equally efficacious in relieving depressive symptoms, although amitriptyline was more efficacious than citalopram in reducing migraine and TTH attacks. Patients who did not respond to monotherapy (<30% of improvement in the clinical scores) were treated with a combination of the two drugs for 16 additional weeks. In these selected patients, the combined treatment produced a substantial improvement in depression, migraine and TTH without producing major side effects such as those commonly related to the 'serotonergic' syndrome. The results indicate that a combined therapy with amitriptyline and citalopram may be particularly beneficial for patients with TTH, migraine and comorbid depression that do not respond to monotherapy.
抗抑郁药用于治疗慢性每日头痛疾病，如偏头痛和慢性紧张型头痛（TTH），这些疾病常与抑郁和焦虑相关。在此，我们研究了单独使用或联合使用阿米替林和西酞普兰对患有抑郁症、TTH和偏头痛“三联”共病患者的疗效和耐受性。88名患者参与了该研究并被随机分为两组。第一组接受阿米替林治疗，第二组接受西酞普兰治疗，为期16周。在第0、4、8和16周对患者进行评估。两种药物在缓解抑郁症状方面同样有效，尽管阿米替林在减少偏头痛和TTH发作方面比西酞普兰更有效。对单一疗法无反应（临床评分改善<30%）的患者再接受两种药物联合治疗16周。在这些选定的患者中，联合治疗使抑郁症、偏头痛和TTH有了显著改善，且未产生诸如通常与“血清素能”综合征相关的严重副作用。结果表明，阿米替林和西酞普兰联合治疗可能对TTH、偏头痛和共病抑郁症且对单一疗法无反应的患者特别有益。
