Bump G M, Reynolds C F, Smith G, Pollock B G, Dew M A, Mazumdar S, Geary M, Houck P R, Kupfer D J
Mental Health Clinical Research Center for the Study of Late-Life Mood Disorders, University of Pittsburgh, PA 15213, USA.
Depress Anxiety. 1997;6(3):113-8.
Elderly depressed patients often require an average of 12 weeks of pharmacotherapy before attaining remission. The delay between treatment initiation and remission may decrease compliance and prolongs suffering; hence, interventions that decrease the time to onset of antidepressant activity are needed. Our objective was to evaluate, in an open trial, the use of one night of total sleep deprivation combined with paroxetine to accelerate antidepressant response in elderly patients. Thirteen elderly patients with major depression were sleep-deprived for one night and started paroxetine on the night of recovery sleep. Patients were followed for twelve weeks, and clinical improvement was rated using the 17-item Hamilton Depression Rating Scale and a version of the Hamilton modified for sleep deprivation studies. 8/13 (62%) patients experienced significant improvement of depressive symptoms by 2 weeks. Within 12 weeks 11/13 (85%) patients responded to the combination of sleep deprivation and paroxetine. Median response time was 2 weeks. Clinical response at 12 weeks was correlated with changes in Sleep Deprivation Depression Rating Scale Scores between baseline and recovery sleep. In an open trial, the combined use of total sleep deprivation and paroxetine appears to be an effective method for speeding the onset of clinical antidepressant activity in geriatric depression and for improving early recognition of non-response.
老年抑郁症患者通常平均需要12周的药物治疗才能达到症状缓解。从开始治疗到症状缓解之间的延迟可能会降低依从性并延长痛苦；因此，需要采取干预措施来缩短抗抑郁活性起效的时间。我们的目的是在一项开放性试验中评估，使用一晚的完全睡眠剥夺联合帕罗西汀，以加速老年患者的抗抑郁反应。13名患有重度抑郁症的老年患者被剥夺睡眠一晚，并在恢复睡眠的当晚开始服用帕罗西汀。对患者进行了为期12周的随访，并使用17项汉密尔顿抑郁量表以及为睡眠剥夺研究修改的汉密尔顿量表版本对临床改善情况进行评分。8/13（62%）的患者在2周时抑郁症状有显著改善。在12周内，11/13（85%）的患者对睡眠剥夺和帕罗西汀的联合治疗有反应。中位反应时间为2周。12周时的临床反应与基线睡眠和恢复睡眠之间睡眠剥夺抑郁量表评分的变化相关。在一项开放性试验中，完全睡眠剥夺与帕罗西汀联合使用似乎是加速老年抑郁症临床抗抑郁活性起效以及改善对无反应的早期识别的有效方法。
