Rabkin J G, Wagner G, Rabkin R
New York State Psychiatric Institute, NY 10032.
J Clin Psychiatry. 1994 Oct;55(10):433-9.
To date, the efficacy of sertraline in treating depression in the context of human immunodeficiency virus (HIV) has not been investigated, despite the agent's advantageous side effect profile, low toxicity with overdose, and lack of adverse effect on the cardiovascular system. This 8-week open trial addresses the efficacy of sertraline in the treatment of depressed HIV-infected persons, as well as its toleration and effects on immune status (T cells and natural killer cells).
Eligibility criteria included a DSM-III-R diagnosis of major depression; among the exclusion criteria were substance abuse, dementia, and severe gastrointestinal complaints. Major outcome variables included the Hamilton Rating Scale for Depression, the Clinical Global Impressions scale, and laboratory tests measuring T cell subsets and natural killer cells.
Twenty-seven gay men and 1 woman entered treatment; 20 completed 8 weeks. Fourteen (70%) of the completers were rated responders. Five of the 8 dropouts (18% of the total sample) discontinued treatment due to side effects. Responders improved significantly on all measures of psychiatric distress as well as quality of life. Those with advanced immunosuppression (CD4 cell count < 200/cu mm) responded as well to treatment as did the others. All T cell subsets, including CD4 cell count, and natural killer cell counts (CD56 and CD57) showed no significant change from baseline to study endpoint, an average of 17 weeks later.
In this small open trial, sertraline was an effective treatment for depression, displayed no apparent adverse effects on immune status, and was generally well tolerated; however, a randomized placebo-controlled study with a larger, more diverse sample is needed to confirm our results.
尽管舍曲林具有有利的副作用特征、过量时毒性低且对心血管系统无不良影响，但迄今为止，尚未对其在人类免疫缺陷病毒（HIV）感染情况下治疗抑郁症的疗效进行研究。这项为期8周的开放性试验探讨了舍曲林治疗HIV感染的抑郁症患者的疗效，以及其耐受性和对免疫状态（T细胞和自然杀伤细胞）的影响。
纳入标准包括符合DSM-III-R对重度抑郁症的诊断；排除标准包括药物滥用、痴呆和严重的胃肠道不适。主要结局变量包括汉密尔顿抑郁评定量表、临床总体印象量表，以及测量T细胞亚群和自然杀伤细胞的实验室检查。
27名男同性恋者和1名女性进入治疗；20人完成了8周的治疗。14名（70%）完成治疗者被评定为有反应者。8名退出者中有5名（占总样本的18%）因副作用而停止治疗。有反应者在所有精神痛苦和生活质量指标上均有显著改善。免疫抑制严重（CD4细胞计数<200/立方毫米）的患者对治疗的反应与其他患者相同。所有T细胞亚群，包括CD4细胞计数，以及自然杀伤细胞计数（CD56和CD57）从基线到研究终点（平均17周后）均无显著变化。
在这项小型开放性试验中，舍曲林是治疗抑郁症的有效药物，对免疫状态无明显不良影响，且总体耐受性良好；然而，需要进行一项更大规模、更多样化样本的随机安慰剂对照研究来证实我们的结果。
