Dodd Seetal, Berk Michael
Department of Clinical & Biomedical Sciences, University of Melbourne, Geelong, Australia.
Expert Rev Neurother. 2008 Sep;8(9):1299-306. doi: 10.1586/14737175.8.9.1299.
Antidepressant monotherapy is a first-line treatment for depression; however, not all sufferers will adequately respond to treatment. When treating a patient with treatment-resistant depression, the clinician needs to consider all factors which may contribute to an inadequate response to an antidepressant. These include accuracy of diagnosis and medication adherence, as well as the patient's personality, lifestyle, life events and social circumstances. If it is determined that treatment resistance is due to failure of efficacy of antidepressant monotherapy, then an augmentation strategy using an atypical antipsychotic may be considered. Treatment using olanzapine/fluoxetine combination (OFC) is one of many options. Four randomized, acute-phase trials have suggested OFC is useful for reducing Montgomery-Asberg Depression Rating Scale scores after inadequate response to antidepressant monotherapy. OFC has been useful at doses of olanzapine/fluoxetine 6/25, 6/50, 12/25 and 12/50 mg/day, with 1/5 mg/day suggested to be an ineffective dose. Treatment with OFC has been associated with some side effects, including weight gain and the metabolic syndrome, somnolence, dry mouth, increased appetite and headache. Treatment decisions therefore need to be made to balance the risks and benefits.
抗抑郁药单一疗法是抑郁症的一线治疗方法；然而，并非所有患者对治疗都会有充分反应。在治疗难治性抑郁症患者时，临床医生需要考虑所有可能导致对抗抑郁药反应不足的因素。这些因素包括诊断的准确性和药物依从性，以及患者的性格、生活方式、生活事件和社会环境。如果确定治疗抵抗是由于抗抑郁药单一疗法疗效不佳所致，那么可以考虑使用非典型抗精神病药的增效策略。使用奥氮平/氟西汀组合（OFC）进行治疗是众多选择之一。四项随机急性期试验表明，在对抗抑郁药单一疗法反应不足后，OFC有助于降低蒙哥马利-阿斯伯格抑郁评定量表得分。OFC在奥氮平/氟西汀剂量为6/25、6/50、12/25和12/50毫克/天时有效，而1/5毫克/天被认为是无效剂量。使用OFC治疗会出现一些副作用，包括体重增加和代谢综合征、嗜睡、口干、食欲增加和头痛。因此，需要在权衡风险和益处后做出治疗决策。
