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首页> 外文期刊>Neuropsychiatric Disease and Treatment >Optimized regimens of combined medications for the treatment of major depressive disorder: a double-blind, randomized-controlled trial
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Optimized regimens of combined medications for the treatment of major depressive disorder: a double-blind, randomized-controlled trial

机译：用于治疗重度抑郁症的联合用药的优化方案：一项双盲，随机对照试验

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Introduction: This study investigated if optimized dose regimens of escitalopram and bupropion combination from treatment initiation can be superior to either drug alone in speed of onset, remission rate, and maintenance of therapeutic efficacy. Methods: Patients from a single site (N=85) within a larger double-blind 12-week trial (N=245) showed a lower dropout rate (14% vs 40%) and used higher doses; therefore, this cohort was analyzed separately. Uniquely at this single site, after 12 weeks, non-remitters on a single drug received the other one in addition and combination non-remitters underwent a switch of escitalopram for duloxetine for a 6-week period. Escitalopram could be given up to 40 mg/day and bupropion up to 450 mg/day. A 6-month prolongation was then implemented in remitters, maintaining the double-blind design throughout. Remission was defined as ≤7 on the 17-item Hamilton Rating Scale for Depression, as in the initial publication. Results: At week 2, combination treatment was superior in remission rate (5/28) compared with both bupropion (0/26) and escitalopram monotherapies (0/31; P =0.03 and P =0.02, respectively). The week 12 remission rate of combination treatment showed a higher rate (15/28) relative to bupropion monotherapy (7/26; P =0.04), but not statistically different from escitalopram monotherapy (11/31; P =0.13). The 6-week augmentation produced remission in 7/21 monotherapy non-remitters and 0/6 in the switch group ( P =0.13). Remission was sustained in 28/31 patients enrolled in the 6-month maintenance. Conclusion: These results suggest that combination of escitalopram and bupropion from treatment initiation is superior to either monotherapy in speed of onset. The addition of a second drug in non-remitters can lead to additional remissions, as shown with other combinations of medications. Treatment prolongation using optimized regimens leads to low relapse rates.
机译：简介：这项研究调查了从治疗开始起依他普仑和安非他酮组合的最佳剂量方案在发作速度，缓解率和维持疗效方面是否优于单独使用任一药物。方法：在较大的双盲12周试验（N = 245）中，来自单个部位（N = 85）的患者显示出较低的辍学率（14％vs 40％），并且使用了更高的剂量;因此，我们对该队列进行了单独分析。唯一的独特之处是，在12周后，单一药物的非缓解者接受了另一种药物的缓解，并且组合非缓解者接受了依他普仑换用度洛西汀的疗程，为期6周。依西酞普兰的最高剂量为40毫克/天，安非他酮的剂量最高为450毫克/天。然后在汇款人中实施了6个月的延长，从而始终保持了双盲设计。与最初的出版物一样，在17项汉密尔顿抑郁量表上，缓解定义为≤7。结果：与安非他酮（0/26）和依他普仑单药治疗（0/31;分别为P = 0.03和P = 0.02）相比，组合治疗在第2周的缓解率（5/28）更好。相对于安非他酮单药治疗（7/26; P = 0.04），联合治疗的第12周缓解率更高（15/28），但与依西酞普兰单药治疗（11/31; P = 0.13）在统计学上无差异。为期6周的增强治疗在7/21次非治疗非缓解患者中获得缓解，而在转换治疗组中则为0/6（P = 0.13）。参加6个月维持治疗的28/31名患者持续缓解。结论：这些结果表明，从治疗开始起依他普仑和安非他酮的组合在起效速度上优于单一疗法。如在其他药物组合中所示，在非缓解者中添加第二种药物会导致其他缓解。使用优化方案延长治疗时间可降低复发率。

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