Rush A J, Armitage R, Gillin J C, Yonkers K A, Winokur A, Moldofsky H, Vogel G W, Kaplita S B, Fleming J B, Montplaisir J, Erman M K, Albala B J, McQuade R D
Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas 75235-9086, USA.
Biol Psychiatry. 1998 Jul 1;44(1):3-14. doi: 10.1016/s0006-3223(98)00092-4.
Sleep disturbances are common in major depressive disorder. In previous open-label trials, nefazodone improved sleep continuity and increased rapid eye movement (REM) sleep, while not affecting stage 3/4 sleep or REM latency: in contrast, fluoxetine suppressed REM sleep. This study compared the objective and subjective effects of nefazodone and fluoxetine on sleep.
This paper reports combined results of three identical, multisite, randomized, double-blind, 8-week, acute-phase trials comparing nefazodone (n = 64) with fluoxetine (n = 61) in outpatients with nonpsychotic major depressive disorder and insomnia. Sleep electroencephalographic (EEG) recordings were gathered at baseline and weeks 2, 4, and 8. Clinical ratings were obtained at weeks 1-4, 6, and 8.
Nefazodone and fluoxetine were equally effective in reducing depressive symptoms; however, nefazodone differentially and progressively increased (while fluoxetine reduced) sleep efficiency and reduced (while fluoxetine increased) the number of awakenings in a linear fashion over the 8-week trial. Fluoxetine, but not nefazodone, prolonged REM latency and suppressed REM sleep. Nefazodone significantly increased total REM sleep time. Clinical evaluations of sleep quality were significantly improved with nefazodone compared with fluoxetine.
Nefazodone and fluoxetine were equally effective antidepressants. Nefazodone was associated with normal objective, and clinician- and patient-rated assessments of sleep when compared with fluoxetine. These differential sleep EEG effects are consistent with the notion that nefazodone and fluoxetine may have somewhat different modes and spectra of action.
睡眠障碍在重度抑郁症中很常见。在之前的开放标签试验中，奈法唑酮改善了睡眠连续性并增加了快速眼动（REM）睡眠，同时不影响3/4期睡眠或REM潜伏期；相比之下，氟西汀抑制REM睡眠。本研究比较了奈法唑酮和氟西汀对睡眠的客观和主观影响。
本文报告了三项相同的、多中心的、随机的、双盲的、为期8周的急性期试验的综合结果，这些试验比较了奈法唑酮（n = 64）与氟西汀（n = 61）对非精神病性重度抑郁症和失眠门诊患者的疗效。在基线以及第2、4和8周收集睡眠脑电图（EEG）记录。在第1 - 4周、6周和8周进行临床评分。
奈法唑酮和氟西汀在减轻抑郁症状方面同样有效；然而，在为期8周的试验中，奈法唑酮以线性方式差异性地且逐渐增加（而氟西汀则降低）睡眠效率，并减少（而氟西汀增加）觉醒次数。氟西汀延长了REM潜伏期并抑制了REM睡眠，而奈法唑酮没有。奈法唑酮显著增加了总的REM睡眠时间。与氟西汀相比，奈法唑酮对睡眠质量的临床评估有显著改善。
奈法唑酮和氟西汀是同样有效的抗抑郁药。与氟西汀相比，奈法唑酮在客观、临床医生和患者对睡眠的评估方面表现正常。这些睡眠脑电图的差异效应与奈法唑酮和氟西汀可能具有 somewhat 不同的作用模式和作用谱的观点一致。
