Ranjan R, Meltzer H Y
Department of Psychiatry, Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA.
Biol Psychiatry. 1996 Aug 15;40(4):253-8. doi: 10.1016/0006-3223(95)00305-3.
The treatment of refractory major depression, including the psychotic subtype, is a therapeutic challenge. Three cases of resistant psychotic depression were treated with clozapine monotherapy, an atypical antipsychotic drug effective in treatment-resistant schizophrenia and mania. Both psychotic and mood symptoms responded well to clozapine monotherapy, although response was delayed in one case. Tardive dyskinesia improved markedly, and tardive dystonia improved moderately in one patient. No patient relapsed during a follow-up period of 4-6 years of clozapine treatment. Clozapine was well-tolerated with few side effects. These observations suggest controlled trials of clozapine in the treatment of psychotic depression that fails to respond to electroconvulsive therapy or typical neuroleptics plus tricyclic antidepressants are indicated. The same is true for the use of clozapine in maintenance treatment for psychotic depression in those cases in which typical neuroleptic drugs are required, in order to reduce the risk of tardive dyskinesia and dystonia.
难治性重度抑郁症（包括伴有精神病性症状的亚型）的治疗是一项治疗挑战。三例难治性精神病性抑郁症患者接受了氯氮平单一疗法治疗，氯氮平是一种非典型抗精神病药物，对难治性精神分裂症和躁狂症有效。氯氮平单一疗法对精神病性症状和情绪症状均有良好疗效，尽管有一例患者的反应出现延迟。迟发性运动障碍明显改善，一名患者的迟发性肌张力障碍中度改善。在氯氮平治疗的4至6年随访期内，无患者复发。氯氮平耐受性良好，副作用较少。这些观察结果表明，对于对电休克治疗或典型抗精神病药物加三环类抗抑郁药无反应的精神病性抑郁症，有必要开展氯氮平治疗的对照试验。对于那些需要使用典型抗精神病药物的精神病性抑郁症患者，为降低迟发性运动障碍和肌张力障碍的风险，在维持治疗中使用氯氮平也是如此。
