Malhotra S, Santosh P J
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
J Psychiatr Res. 1996 Jan-Feb;30(1):51-8. doi: 10.1016/0022-3956(95)00042-9.
This study investigated the therapeutic efficacy of loading doses of imipramine hydrochloride and compared it with that of conventional gradually escalating dose regimen of the same drug in 16 melancholic depressives (DSM III-R), done in a comparative, randomized, double-blind research design. There were four males and four females in each group who were comparable on socio-demographic and clinical variables. The study group received the bolus doses of imipramine on two consecutive days and was free of any antidepressant treatment between day 3 and day 7 of the treatment period, whereas the control group received the conventional regime of gradual escalation of imipramine dose over a period of 7 days. The results indicate that imipramine hydrochloride can relieve depression almost completely within 72 h, if given in high bolus doses, thus challenging the theory of lag period for antidepressant action as an inherent property of this drug. The study shows that the pulse loading dose was superior to a conventional dose regime with regard to both antidepressant efficacy and rapidity of onset of action. The various mechanisms possibly involved in such a dramatic improvement and its implications have been discussed.
本研究采用比较、随机、双盲研究设计，对16例抑郁性抑郁症患者（DSM III-R）进行了调查，研究了负荷剂量的盐酸丙咪嗪的治疗效果，并将其与同一药物的传统逐渐递增剂量方案的治疗效果进行了比较。每组有4名男性和4名女性，他们在社会人口统计学和临床变量方面具有可比性。研究组在连续两天接受丙咪嗪大剂量注射，在治疗期的第3天至第7天期间未接受任何抗抑郁治疗，而对照组在7天的时间内接受丙咪嗪剂量逐渐递增的传统方案。结果表明，如果给予高负荷剂量，盐酸丙咪嗪可在72小时内几乎完全缓解抑郁，从而挑战了抗抑郁作用存在潜伏期这一该药物固有特性的理论。研究表明，脉冲负荷剂量在抗抑郁疗效和起效速度方面均优于传统剂量方案。讨论了可能导致这种显著改善的各种机制及其意义。
