Department of Psychiatry and the Interdisciplinary Program in Neuroscience, Seoul National University College of Medicine and College of Natural Sciences, Seoul, South Korea; the Department of Psychiatry, Catholic University of Korea College of Medicine, Seoul, South Korea; the Brain Institute and the Department of Psychiatry, University of Utah, Salt Lake City; the Department of Psychiatry, Soonchunhyang University College of Medicine, Seoul, South Korea; and the Department of Brain and Cognitive Sciences, Ewha Women's University Graduate School, Seoul, South Korea.
Am J Psychiatry. 2012 Sep;169(9):937-945. doi: 10.1176/appi.ajp.2012.12010009.
Antidepressants targeting monoaminergic neurotransmitter systems, despite their immediate effects at the synaptic level, usually require several weeks of administration to achieve clinical efficacy. The authors propose a strategy of adding creatine monohydrate (creatine) to a selective serotonin reuptake inhibitor (SSRI) in the treatment of patients with major depressive disorder. Such augmentation may lead to a more rapid onset of antidepressant effects and a greater treatment response, potentially by restoring brain bioenergetics at the cellular level.
Fifty-two women with major depressive disorder were enrolled in an 8-week double-blind placebo-controlled clinical trial and randomly assigned to receive escitalopram in addition to either creatine (5 g/day, N=25) or placebo (N=27). Efficacy was primarily assessed by changes in the Hamilton Depression Rating Scale (HAM-D) score.
In comparison to the placebo augmentation group, patients receiving creatine augmentation showed significantly greater improvements in HAM-D score, as early as week 2 of treatment. This differential improvement favoring creatine was maintained at weeks 4 and 8. There were no differences between treatment groups in the proportion of patients who discontinued treatment prematurely (creatine: N=8, 32.0%; placebo: N=5, 18.5%) or in the overall frequency of all reported adverse events (creatine: 36 events; placebo: 45 events).
The current study suggests that creatine augmentation of SSRI treatment may be a promising therapeutic approach that exhibits more rapid and efficacious responses in women with major depressive disorder.
尽管针对单胺能神经递质系统的抗抑郁药在突触水平上具有即时效应，但通常需要数周的给药时间才能达到临床疗效。作者提出了一种在治疗重度抑郁症患者时，在选择性 5-羟色胺再摄取抑制剂（SSRI）上加用肌酸一水合物（肌酸）的策略。这种增强可能会导致更快地出现抗抑郁作用和更大的治疗反应，潜在地通过在细胞水平上恢复大脑生物能量学。
52 名女性重度抑郁症患者参加了一项为期 8 周的双盲安慰剂对照临床试验，并随机分为接受依他普仑加用肌酸（每天 5 克，N=25）或安慰剂（N=27）的组。疗效主要通过汉密尔顿抑郁量表（HAM-D）评分的变化来评估。
与安慰剂增强组相比，接受肌酸增强的患者在治疗的第 2 周时 HAM-D 评分的改善明显更大。这种有利于肌酸的差异改善在第 4 周和第 8 周持续存在。在提前停药的患者比例（肌酸：N=8，32.0%；安慰剂：N=5，18.5%）或报告的所有不良事件的总频率（肌酸：36 次事件；安慰剂：45 次事件）方面，两组之间没有差异。
本研究表明，SSRIs 治疗加用肌酸可能是一种很有前途的治疗方法，在女性重度抑郁症患者中表现出更快和更有效的反应。
