Neurology：三环类药能更好治疗帕金森抑郁

[第1楼 PID5212] 2009-03-24 23:56 帕病不倒翁 写道:

Neurology：三环类药能更好治疗帕金森抑郁

　　美国新泽西医学和牙医大学的门扎(Menza)等研究发现，三环类药物治疗帕金森病(PD)伴发抑郁的疗效可能优于选择性5-羟色胺再摄取抑制剂(SSRI)类药物。相关论文2008年12月17日在线发表于《神经病学》(Neurology)。
　　

以下是被引用的内容:

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该随机对照研究将52例伴有抑郁的PD患者分为3组，分别接受三环类(去甲替林)、SSRI(帕罗西汀)和安慰剂，其中34例患者完成了为期8周的研究。

意向性分析(ITT)显示，接受三环类药物的患者，汉密尔顿抑郁评分(HAM-D)结果的改善幅度显著优于接受SSRI和安慰剂者，HAM-D评分改善达50%以上患者的比例，在三环类患者组为53%，显著高于SSRI组的11%和安慰剂组的24%。在改善患者的焦虑、睡眠状况和社会功能方面，三环类药物显著优于安慰剂，而SSRI与安慰剂无显著差异.三环类药物和SSRI在研究中均耐受良好。

该刊同期发表的述评(2008年12月17日在线发表)认为，该研究的时间较短、样本量小、退组患者多，都可能影响研究结果。另外，对于高龄、病程长、认知功能缺陷严重和接受左旋多巴剂量较大的PD患者，应用三环类抗抑郁药时应注意此类药物对精神状态和心脏的不良影响以及直立性低血压问题。

　　来源： 中国医学论坛报　　２００９.０３.２４
　　出处：http://www.bioon.com/biology/biomed/379569.shtml

[第2楼 PID5212] 2012-08-20 19:27 Robot :

Neurology：三环类药能更好治疗帕金森抑郁 相关

[第3楼 PID5213] 2009-03-24 23:57 帕病不倒翁 写道:

《Neurology：三环类药能更好治疗帕金森抑郁》原文

　　Neurology，doi:10.1212/01.wnl.0000336340.89821.b3，M. Menza，A. Dicke

A controlled trial of antidepressants in patients with Parkinson disease and depression

M. Menza MD*, R. DeFronzo Dobkin PhD, H. Marin MD, M. H. Mark MD, M. Gara PhD, S. Buyske PhD, K. Bienfait PhD, and A. Dicke

From the Departments of Psychiatry (M.M., R.D.D., H.M., M.H.M., M.G., K.B., A.D.) and Neurology (M.M., M.H.M.) at the Robert Wood Johnson Medical School, UMDNJ-University Behavioral HealthCare (M.M., H.M., M.G.), and the Department of Statistics at Rutgers University (S.B.), Piscataway, NJ.

Background: Parkinson disease (PD) is a common neurodegenerative disease affecting up to 1 million individuals in the United States. Depression affects up to 50% of these patients and is associated with a variety of poor outcomes for patients and their families. Despite this, there are few evidence-based data to guide clinical care.

Methods: An NIH-funded, randomized, controlled trial of paroxetine CR, nortriptyline, and placebo in 52 patients with PD and depression. The primary outcomes were the change in the Hamilton Depression Rating Scale (HAM-D) and the percentage of depression responders at 8 weeks.

Results: Nortriptyline was superior to placebo for the change in HAM-D (p < 0.002); paroxetine CR was not. There was a trend for superiority of nortriptyline over paroxetine CR at 8 weeks (p < 0.079). Response rates favored nortriptyline (p = 0.024): nortriptyline 53%, paroxetine CR 11%, placebo 24%. In planned contrasts of response rates, nortriptyline was superior to paroxetine CR (p = 0.034). Nortriptyline was also superior to placebo in many of the secondary outcomes, including sleep, anxiety, and social functioning, while paroxetine CR was not. Both active drug treatments were well tolerated.

Conclusions: Though relatively modest in size, this is the largest placebo-controlled trial done to date in patients with Parkinson disease (PD) and depression. Nortriptyline was efficacious in the treatment of depression and paroxetine CR was not. When compared directly, nortriptyline produced significantly more responders than did paroxetine CR. The trial suggests that depression in patients with PD is responsive to treatment and raises questions about the relative efficacy of dual reuptake inhibitors and selective serotonin reuptake inhibitors.

[第4楼 PID5214] 2009-03-24 23:58 帕病不倒翁 写道:

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地址：http://www.parkinsonism.net/diagnose/1/375.html