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首页> 外文期刊>The journal of clinical psychiatry >Improved insulin sensitivity in 80 nondiabetic patients with MDD after clinical remission in a double-blind, randomized trial of amitriptyline and paroxetine.
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Improved insulin sensitivity in 80 nondiabetic patients with MDD after clinical remission in a double-blind, randomized trial of amitriptyline and paroxetine.

机译：在一项阿米替林和帕罗西汀的双盲，随机试验中，临床缓解后的80名非糖尿病MDD患者改善了胰岛素敏感性。

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OBJECTIVE: There is substantial evidence that depression constitutes a risk factor for type 2 diabetes mellitus. A recent study has shown that high salivary cortisol levels are associated with decreased insulin sensitivity in unmedicated, depressed patients. Further, antidepressive treatment might have differential effects on hypothalamus-pituitary-adrenal (HPA) system activity. Therefore, the aim of the present study was to examine whether insulin sensitivity improves during anti-depressive treatment in depressed patients with declining HPA system activity. METHOD: Eighty inpatients with an episode of major depressive disorder (DSM-IV criteria) were treated in a double-blind, randomized protocol with either amitriptyline or paroxetine over a period of 5 weeks. After 6 drug-free days, an oral glucose tolerance test was performed on day 1 and again 35 days after antidepressive treatment. For quantification of free cortisol levels, saliva was obtained daily at 8:00 a.m. during weeks -1 (washout) and 5. The study was conducted from May 2005 to December 2005. RESULTS: The insulin sensitivity index(Matsuda) increased in only those patients who remitted from major depressive disorder as a result of treatment with either antidepressant (F = 7.0, df 1,74; p < .01), while correcting for body mass index. Further, cortisol concentrations declined in remitters and responders to amitriptyline (F = 2.1, df = 1,70; p < .05), but not in any other subgroup. CONCLUSION: Successful antidepressive treatment with either a selective serotonin reuptake inhibitor or a tricyclic substance increases the sensitivity to insulin in nondiabetic depressed patients. The herein presented longitudinal data do not exclude the HPA system as a major contributor to insulin resistance in depressed patients, but underscore the assumption of additional factors.
机译：目的：有大量证据表明抑郁症是构成2型糖尿病的危险因素。最近的一项研究表明，未经药物治疗的抑郁症患者唾液皮质醇水平高与胰岛素敏感性降低有关。此外，抗抑郁治疗可能会对下丘脑-垂体-肾上腺（HPA）系统活性产生不同的影响。因此，本研究的目的是检查HPA系统活性下降的抑郁症患者抗抑郁治疗期间胰岛素敏感性是否得到改善。方法：对80名重度抑郁症发作患者（DSM-IV标准）进行了5周的双盲，随机方案，阿米替林或帕罗西汀治疗。禁药6天后，在抗抑郁治疗后的第1天和35天再次进行口服葡萄糖耐量试验。为了定量测定游离皮质醇水平，在-1周（冲洗）和5周期间每天8:00上午获得唾液。研究于2005年5月至2005年12月进行。结果：只有其中的胰岛素敏感性指数（Matsuda）增加了因使用任何一种抗抑郁药治疗而从重度抑郁症中缓解的患者（F = 7.0，df 1,74; p <.01），同时校正了体重指数。此外，对阿米替林的缓解者和缓解者的皮质醇浓度下降（F = 2.1，df = 1,70; p <.05），但在任何其他亚组中均没有。结论：选择性5-羟色胺再摄取抑制剂或三环物质成功的抗抑郁治疗可增加非糖尿病抑郁患者对胰岛素的敏感性。本文提供的纵向数据并未排除HPA系统是抑郁症患者胰岛素抵抗的主要因素，但强调了其他因素的假设。

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