Pjrek Edda, Konstantinidis Anastasios, Assem-Hilger Eva, Praschak-Rieder Nicole, Willeit Matthäus, Kasper Siegfried, Winkler Dietmar
Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.
J Psychiatr Res. 2009 May;43(8):792-7. doi: 10.1016/j.jpsychires.2008.11.004. Epub 2009 Feb 23.
The monoaminergic neurotransmitters serotonin and noradrenaline have both been implicated in the pathogenesis of seasonal affective disorder (SAD). However, the differential therapeutic value of selective serotonin reuptake inhibitors (SSRI) and selective noradrenaline reuptake inhibitors (NARI) in SAD has not been assessed until now. This study compares data from two open-label trials with similar methodology investigating the SSRI escitalopram and the NARI reboxetine. 20 SAD patients were treated with escitalopram (10-20mg) and 15 patients received treatment with reboxetine (fixed dosage: 8mg) over 6 weeks. Ratings included the structured interview guide for the Hamilton depression rating scale, SAD version (SIGH-SAD), the clinical global impression of severity (CGI-S) and improvement (CGI-I) and the UKU side effect rating scale. Treatment led to a significant reduction in SIGH-SAD score, CGI-S and CGI-I after one week in the reboxetine group and after two weeks in the escitalopram group. SIGH-SAD score was significantly lower in the reboxetine group at weeks 1, 2 and 4 but not at the end of the study. The response rate (SIGH-SAD <50% of baseline value) and the remission rate (SIGH-SAD <8) were not significantly different after 6 weeks of treatment, but the time to response and to remission was significantly shorter in the reboxetine group. The number and severity of side effects were higher in patients treated with reboxetine at all time points. Thus escitalopram and reboxetine were equally effective in treating SAD on all primary and secondary outcome measures. Reboxetine displayed a faster onset of action, but was associated with more pronounced side effects. Further studies comparing SSRI and NARI in SAD are warranted.
单胺能神经递质5-羟色胺和去甲肾上腺素均与季节性情感障碍（SAD）的发病机制有关。然而，选择性5-羟色胺再摄取抑制剂（SSRI）和选择性去甲肾上腺素再摄取抑制剂（NARI）在SAD中的不同治疗价值至今尚未得到评估。本研究比较了两项采用相似方法的开放标签试验的数据，这两项试验分别研究了SSRI艾司西酞普兰和NARI瑞波西汀。20例SAD患者接受艾司西酞普兰（10 - 20mg）治疗，15例患者接受瑞波西汀（固定剂量：8mg）治疗，为期6周。评估指标包括汉密尔顿抑郁量表季节性情感障碍版（SIGH - SAD）的结构化访谈指南、临床总体严重程度印象（CGI - S）和改善情况（CGI - I）以及UKU副作用评定量表。治疗1周后，瑞波西汀组的SIGH - SAD评分、CGI - S和CGI - I显著降低，而艾司西酞普兰组在治疗2周后出现显著降低。在第1、2和4周时，瑞波西汀组的SIGH - SAD评分显著低于艾司西酞普兰组，但在研究结束时并非如此。治疗6周后，缓解率（SIGH - SAD＜基线值的50%）和治愈率（SIGH - SAD＜8）无显著差异，但瑞波西汀组的起效时间和治愈时间显著更短。在所有时间点，接受瑞波西汀治疗的患者副作用的数量和严重程度更高。因此，在所有主要和次要结局指标上，艾司西酞普兰和瑞波西汀治疗SAD的效果相当。瑞波西汀起效更快，但副作用更明显。有必要开展进一步研究比较SSRI和NARI在SAD中的疗效。
