Rudolph R L, Entsuah R, Chitra R
Wyeth-Ayerst Research, Philadelphia, Pennsylvania 19101, USA.
J Clin Psychopharmacol. 1998 Apr;18(2):136-44. doi: 10.1097/00004714-199804000-00006.
Venlafaxine is the first member of a novel class of antidepressants that inhibits the reuptake of both serotonin and norepinephrine. Clinical trials of venlafaxine have demonstrated its efficacy and safety in the treatment of patients diagnosed with major depression. Because patients who have depression also often have anxiety, recent investigations have focused on determining whether venlafaxine can relieve symptoms of anxiety in depressed patients. We performed a pooled analysis of six short-term trials of venlafaxine, retrospectively measuring anxiety in anxious depressed patients using the Hamilton Rating Scale for Depression (HAM-D), Anxiety/Somatization factor and Anxiety Psychic item scores. Three studies were placebo-controlled, and three were placebo- and active-drug-controlled; active controls were imipramine in two trials and trazodone in the third trial. Patients were categorized as having anxiety accompanying depression if baseline HAM-D Anxiety Psychic item scores were 2 or greater. Anxious depressed patients treated with venlafaxine showed greater improvement than those treated with placebo beginning at week 3, according to the HAM-D Anxiety/Somatization factor score, and beginning at week 1, according to the Anxiety Psychic item score. Both effects were maintained at week 6 of treatment (and at week 12 in the one study of longer duration). Finally, treatment with venlafaxine resulted in a highly significant (p < or = 0.001) improvement in depression scores in patients who were anxious at baseline, compared with placebo-treated patients. The results of this analysis demonstrate that venlafaxine is more effective than placebo in reducing symptoms of anxiety in depressed patients and suggest that venlafaxine may afford a monotherapy option for treating patients who have a comorbid diagnosis of depression with anxiety.
文拉法辛是一类新型抗抑郁药中的首个药物，它可抑制5-羟色胺和去甲肾上腺素的再摄取。文拉法辛的临床试验已证明其在治疗被诊断为重度抑郁症患者方面的有效性和安全性。由于患有抑郁症的患者常常也伴有焦虑症，因此最近的研究集中在确定文拉法辛是否能缓解抑郁症患者的焦虑症状。我们对六项文拉法辛短期试验进行了汇总分析，使用汉密尔顿抑郁量表（HAM-D）、焦虑/躯体化因子和焦虑精神项目评分对焦虑抑郁症患者的焦虑情况进行回顾性测量。三项研究为安慰剂对照试验，三项为安慰剂和活性药物对照试验；活性对照在两项试验中为丙咪嗪，在第三项试验中为曲唑酮。如果基线HAM-D焦虑精神项目评分为2分或更高，则将患者归类为伴有抑郁症的焦虑症患者。根据HAM-D焦虑/躯体化因子评分，从第3周开始，接受文拉法辛治疗的焦虑抑郁症患者比接受安慰剂治疗的患者有更大改善；根据焦虑精神项目评分，从第1周开始就有更大改善。这两种效果在治疗第6周时保持（在一项持续时间更长的研究中在第12周时保持）。最后，与接受安慰剂治疗的患者相比，基线时焦虑的患者接受文拉法辛治疗后抑郁评分有高度显著（p≤0.001）改善。该分析结果表明，文拉法辛在减轻抑郁症患者的焦虑症状方面比安慰剂更有效，并表明文拉法辛可能为治疗合并抑郁症和焦虑症的患者提供一种单一疗法选择。
