Zygmont M, Prigerson H G, Houck P R, Miller M D, Shear M K, Jacobs S, Reynolds C F
The Mental Health Clinical Research Center for the Study of Late-Life Mood Disorders, Department of Psychiatry, University of Pittsburgh Medical Center, PA 15213-2593, USA.
J Clin Psychiatry. 1998 May;59(5):241-5. doi: 10.4088/jcp.v59n0507.
This report presents the results of an open-trial pilot study of paroxetine for symptoms of traumatic grief, compared with the effects of nortriptyline in an archival contrast group.
Data are presented on 15 subjects (4 men, 11 women), ranging in age from 40 to 79 years (mean age = 57 years), who experienced the loss of a spouse (N = 8), child (N =5), grandchild (N = 1), or parent (N = 1). Subjects were required to have a baseline score on the Inventory of Complicated Grief (ICG) of > or = 20. Treatment with paroxetine began at a median of 17 months (range, 6-139 months) after the loss. Paroxetine-treated subjects received a psychotherapy tailored for traumatic grief. Depressive symptoms were assessed by using the Hamilton Rating Scale for Depression (HAM-D). The ICG and the HAM-D were administered weekly over 4 months of paroxetine treatment (median dose = 30 mg/day). The group receiving paroxetine were then compared with a group (N = 22) participating in a separate trial of nortriptyline (median dose = 77.5 mg/day) for treatment of bereavement-related major depressive episodes.
Level of traumatic grief symptoms (ICG) decreased by 53%, and depression ratings (HAM-D) decreased by 54% in paroxetine-treated subjects. Nortriptyline showed clinical effects comparable to those of paroxetine.
Paroxetine may be an effective agent in the treatment of traumatic grief symptoms. A comparison of the paroxetine-treated group with a nortriptyline-treated group suggests that both agents have comparably beneficial effects on the symptoms of traumatic grief (as well as those of depression). However, the higher rate of diagnostic comorbidity in the paroxetine-treated group, together with the greater chronicity of their symptoms and the greater safety of paroxetine in overdose, leads us to favor paroxetine over nortriptyline for traumatic grief symptoms in general psychiatric practice. Further controlled evaluation of paroxetine for traumatic grief is necessary.
本报告展示了一项关于帕罗西汀治疗创伤性悲伤症状的开放性试验性研究结果，并与一个存档对照组中去甲替林的效果进行了对比。
数据来自15名受试者（4名男性，11名女性），年龄在40至79岁之间（平均年龄 = 57岁），他们经历了配偶离世（N = 8）、子女离世（N = 5）、孙辈离世（N = 1）或父母离世（N = 1）。受试者在复杂悲伤量表（ICG）上的基线得分需≥20分。帕罗西汀治疗在丧亲后中位数为17个月（范围为6 - 139个月）时开始。接受帕罗西汀治疗的受试者接受了针对创伤性悲伤的心理治疗。使用汉密尔顿抑郁评定量表（HAM-D）评估抑郁症状。在帕罗西汀治疗的4个月期间（中位数剂量 = 30毫克/天），每周对ICG和HAM-D进行评估。然后将接受帕罗西汀治疗的组与另一组（N = 22）进行比较，后者参与了一项单独的去甲替林试验（中位数剂量 = 77.5毫克/天），用于治疗与丧亲相关的重度抑郁发作。
接受帕罗西汀治疗的受试者中，创伤性悲伤症状水平（ICG）下降了53%，抑郁评分（HAM-D）下降了54%。去甲替林显示出与帕罗西汀相当的临床效果。
帕罗西汀可能是治疗创伤性悲伤症状的有效药物。将帕罗西汀治疗组与去甲替林治疗组进行比较表明，两种药物对创伤性悲伤症状（以及抑郁症状）具有相当的有益效果。然而，帕罗西汀治疗组中诊断合并症的发生率较高，以及其症状的慢性化程度更高，且帕罗西汀在过量服用时安全性更高，这使得我们在一般精神科实践中，对于创伤性悲伤症状更倾向于使用帕罗西汀而非去甲替林。有必要对帕罗西汀治疗创伤性悲伤进行进一步的对照评估。
