Bobo William Victor, Shelton Richard C
Vanderbilt University School of Medicine, Department of Psychiatry, 1500 21st Ave South, Village at Vanderbilt, Nashville, TN 37212, USA.
Expert Opin Pharmacother. 2009 Sep;10(13):2145-59. doi: 10.1517/14656560903130609.
There has been growing evidence supporting the use of atypical antipsychotic drugs as adjunctive treatments in patients with major depression who fail to respond adequately to antidepressants.
To review the efficacy and safety data for one such combination, fluoxetine (FLX) + olanzapine (OLZ) in treatment-resistant depression (TRD).
We reviewed published randomized, controlled acute-phase studies, as well as available long-term clinical studies.
RESULTS/CONCLUSIONS: In each acute-phase study (n = 5), FLX/OLZ group experienced rapid antidepressant effects and, in two of these studies, resulted in significantly greater improvement at study end point compared with antidepressant monotherapy. These effects were strongest when TRD was defined as having failed at least two antidepressant trials during the current depressive episode. FLX + OLZ was generally well tolerated; however, increases in body weight and prolactin levels with FLX + OLZ were greater than that of antidepressant monotherapy groups and were similar to OLZ monotherapy. However, changes in random total cholesterol were also greatest for FLX + OLZ and were greater in magnitude than that of OLZ or FLX monotherapy. Long-term effectiveness/safety data are sparse, and comparison trials and sequential treatment studies involving FLX + OLZ and other antidepressant-atypical antipsychotic combinations are lacking. Thus, the exact place of FLX + OLZ among other available options for TRD is difficult to determine.
越来越多的证据支持在对抗抑郁药反应欠佳的重度抑郁症患者中使用非典型抗精神病药物作为辅助治疗。
回顾一种联合用药，即氟西汀（FLX）+奥氮平（OLZ）治疗难治性抑郁症（TRD）的疗效和安全性数据。
我们回顾了已发表的随机对照急性期研究以及现有的长期临床研究。
结果/结论：在每项急性期研究（n = 5）中，FLX/OLZ组均迅速产生抗抑郁作用，并且在其中两项研究中，与单一抗抑郁药治疗相比，在研究终点时改善更为显著。当将TRD定义为在当前抑郁发作期间至少两次抗抑郁药试验失败时，这些作用最为明显。FLX + OLZ总体耐受性良好；然而，FLX + OLZ导致的体重和催乳素水平升高幅度大于单一抗抑郁药治疗组，且与单一奥氮平治疗相似。但是，FLX + OLZ导致的随机总胆固醇变化也是最大的，且变化幅度大于奥氮平或氟西汀单一治疗。长期有效性/安全性数据较少，并且缺乏涉及FLX + OLZ与其他抗抑郁药-非典型抗精神病药物联合用药的比较试验和序贯治疗研究。因此，很难确定FLX + OLZ在TRD的其他可用治疗方案中的准确地位。
