Schüle Cornelius, Baghai Thomas C, Eser Daniela, Hecht Susanne, Hermisson Igor, Born Christoph, Häfner Sibylle, Nothdurfter Caroline, Rupprecht Rainer
Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.
World J Biol Psychiatry. 2007;8(2):112-22. doi: 10.1080/15622970601136203.
There is preliminary evidence that the atypical antipsychotic aripiprazole, which is a partial agonist at D(2) and 5-HT(1A) receptors and a potent antagonist at 5-HT(2A) receptors, may be useful as an augmentation strategy in treatment-resistant depression.
In this 4-week open-label non-randomized parallel-group study, the safety and efficacy of aripiprazole as add-on treatment strategy in patients suffering from non-delusional depression was investigated. Forty drug-free depressed inpatients without psychotic symptoms (13 men, 27 women), suffering from a major depressive episode or bipolar disorder, depressive state (DSM-IV criteria), were included in the study. The patients were treated either with mirtazapine monotherapy (45 mg/day) or combination therapy (mirtazapine 45 mg/day plus aripiprazole 15 mg/day) for 4 weeks. Safety and efficacy were assessed weekly using the Hamilton Depression Rating Scale, the Simpson-Angus Scale and the Barnes Akathisia Scale.
Mirtazapine monotherapy and combined treatment with mirtazapine and aripiprazole showed comparable antidepressant effects as assessed at the endpoint of the study period. However, additional administration of aripiprazole accelerated the onset of antidepressant action in patients suffering from treatment-resistant depression. Additive use of aripiprazole reduced the mirtazapine-induced increase in the body mass index. Moreover, mirtazapine had favourable effects on aripiprazole-induced akathisia. No other extrapyramidal side effects were seen in the combination therapy group.
Combined therapy with mirtazapine and aripiprazole is a safe and well-tolerated treatment option which may be useful especially in treatment-resistant depression. Double-blind controlled studies are needed to further explore the efficacy and safety of aripiprazole in depressed patients.
有初步证据表明，非典型抗精神病药物阿立哌唑，它是D（2）和5-羟色胺（1A）受体的部分激动剂以及5-羟色胺（2A）受体的强效拮抗剂，可能作为难治性抑郁症的一种增效策略有效。
在这项为期4周的开放标签非随机平行组研究中，调查了阿立哌唑作为附加治疗策略用于非妄想性抑郁症患者的安全性和有效性。40名无精神病症状的未服用过药物的抑郁症住院患者（13名男性，27名女性），患有重度抑郁发作或双相情感障碍、抑郁状态（符合《精神疾病诊断与统计手册》第四版标准），被纳入研究。患者接受米氮平单药治疗（45毫克/天）或联合治疗（米氮平45毫克/天加阿立哌唑15毫克/天），为期4周。每周使用汉密尔顿抑郁量表、辛普森-安格斯量表和巴恩斯静坐不能量表评估安全性和有效性。
在研究期结束时评估，米氮平单药治疗以及米氮平和阿立哌唑联合治疗显示出相当的抗抑郁效果。然而，额外给予阿立哌唑加快了难治性抑郁症患者抗抑郁作用的起效时间。阿立哌唑的附加使用降低了米氮平引起的体重指数增加。此外，米氮平对阿立哌唑引起的静坐不能有有益作用。联合治疗组未观察到其他锥体外系副作用。
米氮平和阿立哌唑联合治疗是一种安全且耐受性良好的治疗选择，尤其可能对难治性抑郁症有用。需要进行双盲对照研究以进一步探索阿立哌唑在抑郁症患者中的疗效和安全性。
