Buysse D J, Reynolds C F, Hoch C C, Houck P R, Kupfer D J, Mazumdar S, Frank E
Department of Psychiatry, University of Pittsburgh School of Medicine, PA 15213, USA.
Neuropsychopharmacology. 1996 Apr;14(4):243-52. doi: 10.1016/0893-133X(95)00114-S.
Our objectives were to determine the effects of nortriptyline and placebo on subjective and EEG sleep measures over 1 year of maintenance therapy in elderly depressed patients and to determine the relationship of such effects to recurrence in nortriptyline or placebo-treated patients during maintenance therapy. EEG and subjective sleep assessments were conducted before and during a maintenance therapy study of patients suffering from major depression. During acute treatment all patients received nortriptyline plus interpersonal psychotherapy (IPT). During maintenance treatment patients were randomly assigned to double-blind treatment in one of four cells: nortriptyline with IPT; nortriptyline with medication clinic (no IPT); placebo with IPT; or placebo with medication clinic. Sleep evaluations were conducted at one point before treatment, one point following remission during continuation nortriptyline/IPT treatment, and at three time points after random assignment to maintenance treatment. The setting was the sleep laboratory of the outpatient depression treatment clinic, and subjects were a convenience sample of media-recruited and clinically referred elderly outpatient depressed patients (n = 72). Complete sleep analyses were conducted for 21 nortriptyline- and 10 placebo-treated patients throughout 1 year of maintenance treatment. The main outcome measures were subjective and EEG sleep measures and the recurrence of major depression. Our results show that nortriptyline acutely and persistently decreased REM sleep, increased phasic REM activity, decreased sleep apnea, and had no effect on periodic limb movements during sleep. Recurrence on maintenance nortriptyline was associated with lower phasic REM activity during early continuation therapy, but EEG sleep measures did not predict recurrence during placebo maintenance therapy. Patients treated with nortriptyline had a lower recurrence rate than those treated with placebo. Better subjective sleep quality and maintenance IPT were associated with a lower rate of recurrence regardless of nortriptyline treatment. It seems that nortriptyline has persistent effects on REM sleep and sleep apnea in elderly depressed patients. Maintenance nortriptyline, maintenance IPT, good subjective sleep quality, and high-phasic REM activity are associated with a reduced likelihood of the recurrence of depression during maintenance therapy.
我们的目标是确定去甲替林和安慰剂对老年抑郁症患者维持治疗1年期间主观睡眠和脑电图睡眠指标的影响，并确定这些影响与去甲替林或安慰剂治疗患者在维持治疗期间复发的关系。在一项针对重度抑郁症患者的维持治疗研究之前和期间进行了脑电图和主观睡眠评估。在急性治疗期间，所有患者均接受去甲替林加人际心理治疗（IPT）。在维持治疗期间，患者被随机分配到四个治疗组之一进行双盲治疗：去甲替林加IPT；去甲替林加药物门诊（无IPT）；安慰剂加IPT；或安慰剂加药物门诊。在治疗前的一个时间点、继续使用去甲替林/IPT治疗缓解后的一个时间点以及随机分配到维持治疗后的三个时间点进行睡眠评估。研究地点是门诊抑郁症治疗诊所的睡眠实验室，研究对象是通过媒体招募和临床转诊的老年门诊抑郁症患者的便利样本（n = 72）。在维持治疗的1年期间，对21名接受去甲替林治疗和10名接受安慰剂治疗的患者进行了完整的睡眠分析。主要结局指标是主观和脑电图睡眠指标以及重度抑郁症的复发情况。我们的结果表明，去甲替林急性且持续地减少快速眼动睡眠、增加快速眼动睡眠的相位活动、减少睡眠呼吸暂停，并且对睡眠期间的周期性肢体运动没有影响。维持使用去甲替林期间的复发与早期继续治疗期间较低的快速眼动睡眠相位活动有关，但脑电图睡眠指标并不能预测安慰剂维持治疗期间的复发。接受去甲替林治疗的患者复发率低于接受安慰剂治疗的患者。无论是否接受去甲替林治疗，更好的主观睡眠质量和维持IPT与较低的复发率相关。去甲替林似乎对老年抑郁症患者的快速眼动睡眠和睡眠呼吸暂停有持续影响。维持使用去甲替林、维持IPT、良好的主观睡眠质量和高快速眼动睡眠相位活动与维持治疗期间抑郁症复发的可能性降低有关。
