Gammon G D, Brown T E
J Child Adolesc Psychopharmacol. 1993 Spring;3(1):1-10. doi: 10.1089/cap.1993.3.1.
ABSTRACT Children and adolescents with attention deficit disorders (usually with comorbid conditions), who had shown inadequate therapeutic responses to methylphenidate, were treated by the addition of fluoxetine to methylphenidate. After 8 weeks in open trial, all 32 patients showed positive therapeutic responses in attention, behavior, and affect. Thirty of the 32 children showed clinically significant responses and the other two had statistically but not clinically significant responses. After 12 weeks of treatment, one patient showed a deterioration in clinical status. The children had improved report card grades in major academic subjects {p < 0.0001), and showed significant improvements (p < 0.0001) on the Children's Global Assessment Scale (C-GAS), Conners Parents Rating Scales (CPRS), and Children's Depression Inventory (CDI). Children who initially appeared more impaired on the C-GAS, CDI, CPRS, and GPA showed more improvement on the combined regimen. No significant side effects were observed, using a gradual elevation of fluoxetine dosage. About 40% of the patients showed substantial clinical effects with doses of fluoxetine below 20 mg daily. These preliminary results suggest that fluoxetine and methylphenidate in combination may be safe and effective for some children with attention-deficit hyperactivity disorder (and with comorbid anxiety or depressive symptoms) who do not show adequate responses to methylphenidate or fluoxetine alone.
对哌甲酯治疗反应欠佳的患有注意力缺陷障碍（通常伴有共病情况）的儿童和青少年，在哌甲酯治疗基础上加用氟西汀进行治疗。开放试验8周后，所有32例患者在注意力、行为和情感方面均显示出积极的治疗反应。32例儿童中有30例显示出具有临床意义的反应，另外2例有统计学意义但无临床意义的反应。治疗12周后，1例患者临床状态恶化。这些儿童主要学科的成绩单成绩有所提高（p<0.0001），在儿童整体评估量表（C-GAS）、康纳斯父母评定量表（CPRS）和儿童抑郁量表（CDI）上均有显著改善（p<0.0001）。最初在C-GAS、CDI、CPRS和平均绩点上表现受损更严重的儿童，在联合治疗方案下改善更明显。采用氟西汀剂量逐渐增加的方法，未观察到明显的副作用。约40%的患者在氟西汀剂量低于每日20mg时即显示出显著的临床效果。这些初步结果表明，对于一些单独使用哌甲酯或氟西汀治疗反应欠佳的患有注意力缺陷多动障碍（以及伴有共病焦虑或抑郁症状）的儿童，氟西汀与哌甲酯联合使用可能是安全有效的。
