Koran Lorrin M, Gamel Nona N, Choung Helen W, Smith Emily H, Aboujaoude Elias N
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA.
J Clin Psychiatry. 2005 Apr;66(4):515-20.
Many patients with obsessive-compulsive disorder (OCD) experience little response to standard treatment with serotonin reuptake inhibitors. Mirtazapine enhances serotonergic function by a mechanism distinct from reuptake inhibition. Because a pilot study suggested effectiveness of mirtazapine in OCD, we conducted a controlled trial.
We recruited 30 subjects, 15 treatmentnaive and 15 treatment-experienced, with DSM-IV OCD of > or =1 year's duration and a Yale-Brown Obsessive Compulsive Scale (YBOCS) score of > or =20. In the 12-week, open-label phase, subjects received mirtazapine starting at 30 mg/day and titrated over 2 weeks as tolerated to 60 mg/day. At week 12, responders (YBOCS score decrease > 25%) were randomly assigned, double-blind, to continue mirtazapine or switch to placebo for 8 weeks, including a 1-week, double-blind taper week for placebo subjects.
In the open-label phase, the mean +/-SD YBOCS score fell from 28.3 +/-3.7 to 20.3 +/-8.5 (paired samples t = 4.81, p < .0001). Four subjects (13.3%) discontinued for side effects. Sixteen subjects (53.3%) (8 treatmentnaive, 8 treatment-experienced) were responders and 15 agreed to randomization. Response was independent of comorbid mood disorders. In the 8-week, double-blind, placebo-controlled discontinuation phase, the mirtazapine group's mean YBOCS score fell a mean +/-SD of 2.6 +/-8.7 points while the placebo group's mean score rose a mean +/-SD of 9.1 +/-7.5 points (Mann Whitney U = 6.5, p = .005, 1-tailed). All other outcome measures were consistent with mirtazapine's superiority versus placebo.
Mirtazapine may be an effective pharmacotherapy for OCD. If our results are replicated, larger double-blind studies would be indicated.
许多强迫症（OCD）患者对5-羟色胺再摄取抑制剂的标准治疗反应甚微。米氮平通过一种不同于再摄取抑制的机制增强5-羟色胺能功能。由于一项初步研究表明米氮平对强迫症有效，我们进行了一项对照试验。
我们招募了30名受试者，其中15名未接受过治疗，15名有过治疗经历，患有病程≥1年的DSM-IV强迫症，耶鲁-布朗强迫症量表（YBOCS）评分≥20。在为期12周的开放标签阶段，受试者从30毫克/天开始服用米氮平，并在2周内根据耐受情况逐渐增至60毫克/天。在第12周时，有反应者（YBOCS评分降低>25%）被随机双盲分配，继续服用米氮平或改用安慰剂，为期8周，其中安慰剂组受试者有1周的双盲减量期。
在开放标签阶段，YBOCS评分均值±标准差从28.3±3.7降至20.3±8.5（配对样本t=4.81，p<.0001）。4名受试者（13.3%）因副作用停药。16名受试者（53.3%）（8名未接受过治疗，8名有过治疗经历）有反应，15名同意随机分组。反应与共病情绪障碍无关。在为期8周的双盲、安慰剂对照停药阶段，米氮平组的YBOCS评分均值±标准差下降了2.6±8.7分，而安慰剂组的评分均值±标准差上升了9.1±7.5分（曼-惠特尼U=6.5，p=.005，单尾）。所有其他结果指标均表明米氮平优于安慰剂。
米氮平可能是一种有效的强迫症药物治疗方法。如果我们的结果得到重复验证，则需要进行更大规模的双盲研究。
