Politis Antonis M, Papadimitriou George N, Theleritis Christos G, Psarros Constantin, Soldatos Constantin R
Department of Psychiatry, Athens University Medical School, Eginition Hospital, Athens, Greece.
Prog Neuropsychopharmacol Biol Psychiatry. 2008 Jul 1;32(5):1227-30. doi: 10.1016/j.pnpbp.2008.03.011. Epub 2008 Mar 25.
Psychotic depression is classified as a clinical subtype of major depressive disorder. The combination of an antidepressant with an antipsychotic agent has been demonstrated to be efficacious for the treatment of psychotic depression. However, in elderly patients with psychotic depression, little information is available on the efficacy of such combinations. Therefore, we have evaluated combination treatment for 5 weeks with amisulpride and antidepressants in non-demented elderly patients with psychotic depression. Eleven patients were treated with either citalopram 20-40 mg/day (n=5) or mirtazapine 30-60 mg/day (n=6), and amisulpride 75-100 mg/day for 5 weeks. Clinical status was evaluated at baseline and after 3 and 5 weeks using the Brief Psychiatric Rating Scale (BPRS), the Hamilton Depression Rating Scale--17 items (HDRS) and the Clinical Global Impression Scale (CGI-S). In 5 of the 11 patients there was remission of depression, while in another 5 patients there was partial remission of depression and in one patient there was no remission. Finally, there was resolution of psychotic symptoms in all the patients involved. One patient developed tremor and rigidity but insisted on continuing with the drug since her psychopathology has improved considerably after the addition of amisulpride to antidepressant treatment. In conclusion, some of the elderly patients with psychotic depression may benefit from the combination of amisulpride and antidepressant pharmacotherapy.
精神病性抑郁被归类为重度抑郁症的一种临床亚型。抗抑郁药与抗精神病药联合使用已被证明对治疗精神病性抑郁有效。然而，对于患有精神病性抑郁的老年患者，关于这种联合用药疗效的信息却很少。因此，我们评估了氨磺必利与抗抑郁药联合治疗5周对非痴呆老年精神病性抑郁患者的效果。11例患者接受了为期5周的治疗，其中5例患者每天服用20 - 40毫克西酞普兰（n = 5），6例患者每天服用30 - 60毫克米氮平（n = 6），同时每天服用75 - 100毫克氨磺必利。在基线时以及3周和5周后，使用简明精神病评定量表（BPRS）、汉密尔顿抑郁评定量表17项版（HDRS）和临床总体印象量表（CGI - S）对临床状态进行评估。11例患者中有5例抑郁症状缓解，另有5例患者部分缓解，1例患者未缓解。最后，所有参与患者的精神病性症状均得到缓解。1例患者出现震颤和强直，但由于在抗抑郁治疗中加用氨磺必利后其精神病理学症状有显著改善，所以坚持继续用药。总之，一些老年精神病性抑郁患者可能从氨磺必利与抗抑郁药物联合治疗中获益。
