Safer Debra L, Arnow Katherine D
Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Stanford, California, USA.
Innov Clin Neurosci. 2012 Mar;9(3):13-6.
Duloxetine, a serotonin norepinephrine reuptake inhibitor (SNRI) indicated for the treatment of depression, is used for off-label purposes such as treatment-resistant obsessive compulsive disorder, bulimia, and binge eating disorder. Although establishing a dose-response relationship for antidepressants in the treatment of depression is difficult, it is possible that for certain patterns of comorbidity, suprathreshold doses may be important to achieve remission. There is currently a paucity of literature regarding the use of suprathreshold doses of duloxetine in treatment refractory cases. This case report describes a clinical situation in which suprathreshold duloxetine was used to treat a patient with severe depression as well as co-morbid anorexia nervosa binge-purging type and obsessive compulsive disorder. One year after the initial increase to 180mg, the patient's mood remains improved. Our clinical account appears to be only the second case report describing the efficacy of high dose 180mg duloxetine in the management of symptoms refractory to treatment at standard doses.
度洛西汀是一种用于治疗抑郁症的5-羟色胺去甲肾上腺素再摄取抑制剂（SNRI），也被用于治疗难治性强迫症、神经性贪食症和暴饮暴食症等未获批的适应症。虽然在抑郁症治疗中建立抗抑郁药的剂量反应关系很困难，但对于某些共病模式，超阈值剂量可能对实现缓解很重要。目前关于在治疗难治性病例中使用超阈值剂量度洛西汀的文献很少。本病例报告描述了一种临床情况，即使用超阈值剂量的度洛西汀治疗一名患有重度抑郁症以及共病神经性厌食症暴食-清除型和强迫症的患者。在最初增加到180毫克一年后，患者的情绪仍有改善。我们的临床病例似乎是第二例描述高剂量180毫克度洛西汀在治疗标准剂量难治性症状方面疗效的病例报告。
