Dunner D L, Hendrickson H E, Bea C, Budech C B
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle 98105, USA.
J Clin Psychiatry. 1997 Dec;58(12):528-31. doi: 10.4088/jcp.v58n1203.
Dysthymic disorder is a chronic depression that is usually characterized by depression rating scale scores that are lower than those for major depressive disorder. Recent studies suggest that pharmacotherapy is quite effective in the treatment of patients with this condition and, in particular, that the newer antidepressants may be better tolerated than older tricyclic antidepressants. The purpose of this study was to investigate the use of a structurally novel antidepressant, venlafaxine, in the treatment of dysthymic disorder.
Seventeen patients with dysthymic disorder were entered into the study, and 14 completed it. A psychiatric interview was used to establish diagnosis, and behavior was assessed by using the Hamilton Rating Scale for Depression (HAM-D) and the Beck Depression Inventory (BDI). Patients were seen over a 9-week period, and venlafaxine treatment proceeded on an open-label basis, from a starting dose of 18.75 mg b.i.d. to a maximum dose of 225 mg/day.
Two patients discontinued early because of side effects, and 1 patient took a single dose, felt better, and did not complete the trial. Analyses of all 17 patients showed significant improvement in HAM-D and BDI scores at the end of the study. Among the completers, there were two response patterns: one group of 7 patients responded quickly to low-dose (75 mg) venlafaxine, and a second group of 7 required the maximum dose. Three of the 7 high-dose patients showed considerable improvement. Side effects in this study were generally in keeping with what has been reported using venlafaxine in treatment of major depressive disorder. No patients evidenced increased blood pressure.
Our study supports the treatment of dysthymic patients with venlafaxine, which has equal efficacy and greater tolerability than tricyclic antidepressants.
恶劣心境障碍是一种慢性抑郁症，其特征通常是抑郁评定量表得分低于重度抑郁症患者。近期研究表明，药物治疗对这种疾病的患者相当有效，尤其是新型抗抑郁药可能比老式三环类抗抑郁药耐受性更好。本研究的目的是调查一种结构新颖的抗抑郁药文拉法辛在恶劣心境障碍治疗中的应用。
17例恶劣心境障碍患者进入本研究，14例完成研究。采用精神科访谈进行诊断，并用汉密尔顿抑郁评定量表（HAM-D）和贝克抑郁量表（BDI）评估行为。患者在9周内接受观察，文拉法辛治疗采用开放标签方式，起始剂量为每日两次，每次18.75mg，最大剂量为225mg/天。
2例患者因副作用提前停药，1例患者服用单剂后感觉好转，未完成试验。对所有17例患者的分析显示，研究结束时HAM-D和BDI得分有显著改善。在完成研究的患者中，有两种反应模式：一组7例患者对低剂量（75mg）文拉法辛反应迅速，另一组7例患者需要最大剂量。7例高剂量患者中有3例有显著改善。本研究中的副作用总体上与使用文拉法辛治疗重度抑郁症的报道一致。没有患者出现血压升高。
我们的研究支持用文拉法辛治疗恶劣心境障碍患者，其疗效与三环类抗抑郁药相当，耐受性更好。
