Hellerstein David J, Hunnicutt-Ferguson Kallio, Stewart Jonathan W, McGrath Patrick J, Keller Samantha, Peterson Bradley S, Chen Ying
New York State Psychiatric Institute, New York, NY, USA; Columbia University College of Physicians and Surgeons, New York, NY, USA.
New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA.
J Affect Disord. 2017 Mar 1;210:258-264. doi: 10.1016/j.jad.2016.12.026. Epub 2016 Dec 20.
To determine efficacy of continued treatment with the serotonin norepinephrine reuptake inhibitor duloxetine on symptom reduction and functional improvement in outpatients with dysthymia.
Fifty outpatients with DSM-IV-TR diagnosed dysthymia who had participated in a 10 week double-blind, placebo-controlled study of duloxetine received open treatment for three months. Nineteen duloxetine responders continued duloxetine, 24 patients initially treated with placebo started open duloxetine treatment, and 7 duloxetine non-responders were treated with desvenlafaxine or bupropion, selected by clinician choice.
Patients continuing duloxetine maintained symptom improvement, 84% meeting response and 63% remission criteria at week 22. Patients initially treated with placebo showed similarly high levels of response (83%) and remission (62%) at week 22, and most duloxetine non-responders subsequently responded to other antidepressants. Duloxetine-continuation patients improved modestly between weeks 10 and 22 on measures of social and cognitive functioning and temperament. Despite this improvement concurrently across several functional domains, 66.7% of patients continuing duloxetine remained in the impaired range of functioning according to the Social Adjustment Scale (SAS).
Continued duloxetine treatment appears to be effective in maintaining symptom response in dysthymic disorder, and has positive effects on social functioning. However, the majority of patients do not show normalization of functioning, even when controlling for remission status. Additional treatments should be considered to target residual impairments in social functioning in mood remitted patients with persistent depressive disorder.
确定5-羟色胺去甲肾上腺素再摄取抑制剂度洛西汀持续治疗对心境恶劣障碍门诊患者症状减轻及功能改善的疗效。
50名被诊断为DSM-IV-TR标准下心境恶劣障碍的门诊患者，他们参与了一项为期10周的度洛西汀双盲、安慰剂对照研究，之后接受了3个月的开放治疗。19名度洛西汀治疗有反应的患者继续使用度洛西汀，24名最初接受安慰剂治疗的患者开始接受度洛西汀开放治疗，7名度洛西汀治疗无反应的患者由临床医生选择给予去甲文拉法辛或安非他酮治疗。
继续使用度洛西汀的患者症状持续改善，在第22周时，84%达到反应标准，63%达到缓解标准。最初接受安慰剂治疗的患者在第22周时也显示出同样高的反应率（83%）和缓解率（62%），大多数度洛西汀治疗无反应的患者随后对其他抗抑郁药有反应。继续使用度洛西汀的患者在第10周至22周期间，在社交、认知功能和气质测量方面有适度改善。尽管在几个功能领域同时出现这种改善，但根据社会适应量表（SAS），继续使用度洛西汀的患者中有66.7%的功能仍处于受损范围。
持续使用度洛西汀治疗似乎对维持心境恶劣障碍的症状反应有效，且对社交功能有积极影响。然而，即使控制缓解状态，大多数患者的功能也未恢复正常。对于持续性抑郁障碍情绪缓解患者的社交功能残留损害，应考虑采用其他治疗方法。
