Wroblewski B A, Joseph A B, Cornblatt R R
Greenery Rehabilitation Center, Boston, MA 02135, USA.
J Clin Psychiatry. 1996 Dec;57(12):582-7. doi: 10.4088/jcp.v57n1206.
Untreated or poorly treated depression in patients who suffer from traumatic brain injury can result in greater functional disability and prolonged or ineffective hospital and rehabilitation stays. Literature available on the pharmacologic treatment of depression after traumatic brain injury is scarce. This study investigated in a controlled and prospective manner the use of desipramine, a tricyclic antidepressant, in a series of patients with severe traumatic brain injury.
Ten patients with severe traumatic brain injury and long-standing depression, as diagnosed by DSM-III-R criteria, were admitted to the study because of the intention to be treated with antidepressants. They were randomly assigned to blindly start on either desipramine treatment (N = 6) or placebo lead-in (N = 4). Patients starting with desipramine stayed on that drug; patients starting with placebo lead-in were blindly crossed over to desipramine after 1 month if there was no significant improvement demonstrated by DSM-III-R criteria. All rating clinicians, physicians, and patients were blind to actual treatment and any ratings data. DSM-III-R evaluations were done monthly. An affect/mood scale was done every 2 weeks.
Of all patients evaluable using the DSM-III-R, 6 (86%) of 7 demonstrated resolution of depression and depressed mood during desipramine treatment. (Three received desipramine throughout the study; 3 others started taking placebo and crossed over to desipramine,) One patient refused evaluation on DSM-III-R throughout; 2 patients, both on desipramine, dropped out because of adverse effects (seizure, mania). In addition, there was statistically significant (p = .001) improvement over time and different rates of improvement over time in the treated and untreated groups for the affect/mood scale data.
Results from this small study, utilizing a blinded, placebo lead-in design appear to (1) demonstrate the clinically significant effectiveness of desipramine in treating long-standing depression in a series of patients with severe traumatic brain injury, as rated with DSM-III-R criteria; (2) show statistically significant improvement on the affect/mood scale data, favoring the treated versus untreated (placebo lead-in) group.
创伤性脑损伤患者中，未经治疗或治疗不当的抑郁症会导致更严重的功能残疾，以及住院和康复时间延长或效果不佳。关于创伤性脑损伤后抑郁症药物治疗的现有文献很少。本研究以对照和前瞻性的方式，对一系列重度创伤性脑损伤患者使用三环类抗抑郁药去甲丙咪嗪进行了调查。
10例根据《精神疾病诊断与统计手册》第三版修订版（DSM-III-R）标准诊断为重度创伤性脑损伤且患有长期抑郁症的患者，因有意接受抗抑郁药治疗而被纳入研究。他们被随机分配，盲目地开始接受去甲丙咪嗪治疗（N = 6）或安慰剂导入治疗（N = 4）。开始使用去甲丙咪嗪的患者继续使用该药物；开始接受安慰剂导入治疗的患者，如果在1个月后根据DSM-III-R标准未显示出明显改善，则盲目交叉接受去甲丙咪嗪治疗。所有评级的临床医生、医生和患者均对实际治疗情况及任何评级数据不知情。每月进行DSM-III-R评估。每2周进行一次情感/情绪量表评估。
在所有可根据DSM-III-R进行评估的患者中，7例中有6例（86%）在去甲丙咪嗪治疗期间抑郁症和抑郁情绪得到缓解。（3例在整个研究过程中接受去甲丙咪嗪治疗；另外3例开始服用安慰剂，之后交叉接受去甲丙咪嗪治疗。）1例患者始终拒绝接受DSM-III-R评估；2例服用去甲丙咪嗪的患者因不良反应（癫痫、躁狂）退出。此外，情感/情绪量表数据显示，治疗组和未治疗组随时间有统计学意义（p = .001）的改善，且随时间的改善率不同。
这项采用盲法、安慰剂导入设计的小型研究结果似乎表明：（1）根据DSM-III-R标准评定，去甲丙咪嗪在治疗一系列重度创伤性脑损伤患者的长期抑郁症方面具有临床显著疗效；（2）在情感/情绪量表数据上有统计学意义的改善，治疗组优于未治疗（安慰剂导入）组。
