Montgomery S A
Academic Department of Psychiatry, St Mary's Hospital Medical School, London UK.
Int Clin Psychopharmacol. 1995 Mar;10 Suppl 2:21-7. doi: 10.1097/00004850-199503002-00005.
It is important to evaluate a new antidepressant in terms of its efficacy in relation to that of reference agents such as the tricyclics and monoamine oxidase inhibitors. Newer antidepressants have not been shown to be more effective than the reference agents, either in the proportion of patients in whom they produce a therapeutic response or in their speed of onset of antidepressant activity. The serotonin-noradrenaline reuptake inhibitor (SNRI) venlafaxine appears to offer some advantages in both of these areas. In a number of short-term placebo- and comparator-controlled trials, venlafaxine was shown to be as effective as, and in some cases more effective than, the reference antidepressants. These findings were also substantiated in meta-analyses of both short-term and long-term comparator-controlled studies. In terms of its onset of activity, venlafaxine was shown to produce statistically significant differences from placebo as early as Day 4 in a study in severely depressed in-patients with melancholia and by Week 1 in a study in out-patients with major depression. A rationale is presented to define the clinical relevance of these findings.
根据新型抗抑郁药与三环类药物和单胺氧化酶抑制剂等对照药物相比的疗效来评估它是很重要的。无论是在产生治疗反应的患者比例方面，还是在抗抑郁活性的起效速度方面，新型抗抑郁药都未被证明比对照药物更有效。5-羟色胺去甲肾上腺素再摄取抑制剂（SNRI）文拉法辛在这两个方面似乎都具有一些优势。在一些短期安慰剂对照和比较对照试验中，文拉法辛被证明与对照抗抑郁药一样有效，在某些情况下甚至更有效。这些发现也在短期和长期比较对照研究的荟萃分析中得到了证实。就其活性起效而言，在一项针对重度抑郁住院忧郁症患者的研究中，文拉法辛早在第4天就显示出与安慰剂有统计学上的显著差异；在一项针对门诊重度抑郁症患者的研究中，到第1周时显示出与安慰剂有统计学上的显著差异。本文提出了一个基本原理来界定这些发现的临床意义。
