McDougle C J, Price L H, Goodman W K, Charney D S, Heninger G R
Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.
J Clin Psychopharmacol. 1991 Jun;11(3):175-84.
Two- and 4-week double-blind placebo-controlled trials of lithium augmentation of ongoing fluvoxamine treatment trials were conducted in 20 and 10 patients, respectively, with primary obsessive-compulsive disorder (OCD) who had failed to respond to fluvoxamine alone. Although 2 weeks of double-blind lithium augmentation produced a small but statistically significant reduction in obsessive-compulsive symptoms, most patients did not have a clinically meaningful response. Furthermore, there was no statistical or clinical improvement in obsessive-compulsive symptoms during the subsequent 4-week double-blind, placebo-controlled trial of lithium augmentation. On the basis of treatment response criteria, only 18% and 0% of the patients responded to lithium augmentation of fluvoxamine during the 2- and 4-week treatment trials, respectively. In light of the previously reported 44% response rate to lithium augmentation in treatment-resistant depressed patients on fluvoxamine, the results of this study suggest that pathophysiological differences may exist between OCD and depression. The routine use of lithium augmentation in the management of patients with OCD who are refractory to serotonin reuptake inhibitors is not supported by these findings.
分别对20例和10例患有原发性强迫症（OCD）且单独使用氟伏沙明治疗无效的患者进行了为期2周和4周的双盲安慰剂对照试验，试验内容为在持续进行的氟伏沙明治疗基础上加用锂盐。尽管为期2周的双盲加用锂盐治疗使强迫症状有轻微但具有统计学意义的减轻，但大多数患者并无临床上有意义的反应。此外，在随后为期4周的双盲、安慰剂对照的加用锂盐试验中，强迫症状在统计学和临床上均无改善。根据治疗反应标准，在2周和4周治疗试验期间，分别仅有18%和0%的患者对氟伏沙明加用锂盐治疗有反应。鉴于之前报道对氟伏沙明治疗无效的抑郁症患者加用锂盐的有效率为44%，本研究结果提示强迫症与抑郁症之间可能存在病理生理差异。这些研究结果不支持在对5-羟色胺再摄取抑制剂难治的强迫症患者管理中常规加用锂盐。
