Shin Cheolmin, Jeon Sang Won, Lee Seung-Hoon, Pae Chi-Un, Hong Narei, Lim Hyun Kook, Patkar Ashwin A, Masand Prakash S, An Hyonggin, Han Changsu
Department of Psychiatry, Korea University Ansan Hospital, Korea University College of Medicine, Seoul, Korea.
Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Clin Psychopharmacol Neurosci. 2023 Feb 28;21(1):135-146. doi: 10.9758/cpn.2023.21.1.135.
Anxious depression is associated with greater chronicity, higher severity of symptoms, more severe functional impairment, and poor response to drug treatment. However, evidence for first-choice antidepressants in patients with anxious depression is limited. This study aimed to compare the efficacy and safety of escitalopram, desvenlafaxine, and vortioxetine in the acute treatment of anxious depression.
Patients (n = 124) with major depressive disorder and high levels of anxiety were randomly assigned to an escitalopram treatment group (n = 42), desvenlafaxine treatment group (n = 40), or vortioxetine treatment group (n = 42) in a 6-week randomized rater-blinded head-to-head comparative trial. Changes in overall depressive and anxiety symptoms were assessed using the 17-item Hamilton Depression Rating Scale (HAMD) and Hamilton Anxiety Rating Scale (HAMA), respectively.
Patients demonstrated similar baseline-to-endpoint improvement in scores and similar response and remission rates for HAMD and HAMA. Analysis of the individual HAMD items revealed that desvenlafaxine significantly reduced anxiety somatic scores ( = 0.013) and hypochondriasis scores ( = 0.014) compared to escitalopram. With respect to the individual HAMA items, desvenlafaxine treatment showed significantly lower scores for respiratory symptoms ( = 0.013) than escitalopram treatment and cardiovascular symptoms ( = 0.005) than vortioxetine treatment. The treatments were well tolerated, with no significant differences.
Our results indicated no significant differences in the efficacy and tolerability of escitalopram, desvenlafaxine, and vortioxetine in this subtype of patients with anxious depression during the acute phase of treatment.
焦虑抑郁与更高的慢性化程度、更严重的症状、更严重的功能损害以及对药物治疗的不良反应相关。然而，关于焦虑抑郁患者首选抗抑郁药的证据有限。本研究旨在比较艾司西酞普兰、度洛西汀和伏硫西汀在急性治疗焦虑抑郁中的疗效和安全性。
在一项为期6周的随机、评估者盲法、头对头比较试验中，将124例伴有高度焦虑的重度抑郁症患者随机分配至艾司西酞普兰治疗组（n = 42）、度洛西汀治疗组（n = 40）或伏硫西汀治疗组（n = 42）。分别使用17项汉密尔顿抑郁量表（HAMD）和汉密尔顿焦虑量表（HAMA）评估总体抑郁和焦虑症状的变化。
患者在HAMD和HAMA评分上从基线到终点的改善相似，反应率和缓解率也相似。对HAMD各单项的分析显示，与艾司西酞普兰相比，度洛西汀显著降低了焦虑躯体症状评分（P = 0.013）和疑病症状评分（P = 0.014）。就HAMA各单项而言，度洛西汀治疗的呼吸症状评分（P = 0.013）显著低于艾司西酞普兰治疗，心血管症状评分（P = 0.005）低于伏硫西汀治疗。这些治疗耐受性良好，无显著差异。
我们的结果表明，在治疗急性期，艾司西酞普兰、度洛西汀和伏硫西汀在这类焦虑抑郁亚型患者中的疗效和耐受性无显著差异。
