Kallepalli B R, Bhatara V S, Fogas B S, Tervo R C, Misra L K
Department of Psychiatry, University of South Dakota School of Medicine, Sioux Falls, USA.
J Child Adolesc Psychopharmacol. 1997 Summer;7(2):97-107. doi: 10.1089/cap.1997.7.97.
This retrospective chart review examined the relative effectiveness of fluoxetine and trazodone in relieving insomnia associated with depressive disorders in adolescents (aged 13-17 years). We reviewed the hospital charts of consecutively admitted adolescents with a depressive disorder and insomnia, who received one of three treatments: fluoxetine (20 +/- 2.2 mg), trazodone (71 +/- 32 mg), or a fluoxetine-trazodone combination (fluoxetine 29 +/- 2.2 mg, trazodone 68 +/- 29 mg). Each treatment was examined in 20 patients. Insomnia was defined as a change in sleep patterns characterized by decreased total sleep time that was sufficient to cause clinical concern, and insomnia resolution was defined as sleep starting by midnight and lasting 6 hours. Mean time to resolution of insomnia was significantly faster in adolescents treated with trazodone rather than fluoxetine (2.5 vs. 5.1 days, p < 0.05). Trazodone seemed to save only about 3 days and insomnia resolved in all subjects by the 11th day of antidepressant treatment. Median time to insomnia resolution was 2 days (range 1-5 days) in the trazodone group and 4 days (range 1-11 days) in the fluoxetine group. This difference between trazodone and fluoxetine, although statistically significant, was generally not clinically significant in the management of insomnia associated with depressive disorders in adolescents. The resolution of insomnia was not faster for treatment with a combination of fluoxetine and trazodone in comparison to fluoxetine monotherapy. Insomnia resolution was slightly later in older children. These clinical findings await confirmation by a controlled study. Both drugs seemed effective in ameliorating sleep symptoms in this sample, although it is likely that they produced these changes by different mechanisms.
这项回顾性病历审查研究了氟西汀和曲唑酮在缓解青少年（13至17岁）抑郁症相关失眠方面的相对有效性。我们回顾了连续收治的患有抑郁症和失眠的青少年的医院病历，这些青少年接受了三种治疗之一：氟西汀（20±2.2毫克）、曲唑酮（71±32毫克）或氟西汀 - 曲唑酮联合用药（氟西汀29±2.2毫克，曲唑酮68±29毫克）。每种治疗方法各有20名患者接受。失眠被定义为睡眠模式的改变，其特征是总睡眠时间减少，足以引起临床关注，失眠缓解被定义为午夜前入睡并持续6小时。接受曲唑酮治疗的青少年失眠缓解的平均时间明显快于接受氟西汀治疗的青少年（2.5天对5.1天，p<0.05）。曲唑酮似乎仅节省约3天时间，并且在抗抑郁治疗的第11天所有受试者的失眠均得到缓解。曲唑酮组失眠缓解的中位时间为2天（范围1 - 5天），氟西汀组为4天（范围1 - 11天）。曲唑酮和氟西汀之间的这种差异虽然具有统计学意义，但在青少年抑郁症相关失眠的管理中通常不具有临床意义。与氟西汀单药治疗相比，氟西汀和曲唑酮联合治疗的失眠缓解速度并不更快。年龄较大的儿童失眠缓解稍晚。这些临床发现有待对照研究的证实。在这个样本中，两种药物似乎都能有效改善睡眠症状，尽管它们可能通过不同机制产生这些变化。
