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首页> 外文期刊>The journal of clinical psychiatry >Lithium augmentation compared with phenelzine in treatment-resistant depression in the elderly: an open, randomized, controlled trial.
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Lithium augmentation compared with phenelzine in treatment-resistant depression in the elderly: an open, randomized, controlled trial.

机译：在老年人的难治性抑郁症中，与非那嗪相比，锂的增加：一项开放，随机，对照试验。

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BACKGROUND: Up to a third of elderly patients with major depressive disorder do not respond to a first course of treatment with an antidepressant. There is a lack of controlled studies evaluating therapies for treatment-resistant depression in late-life depression, and no randomized controlled studies assessing the efficacy and tolerability of lithium augmentation in elderly patients have been published. METHOD: Twenty-nine elderly inpatients with major depressive disorder according to DSM-IV criteria who had previously failed to respond to 1 or more adequate trials with a tricyclic antidepressant or venlafaxine were included in a 6-week, open, randomized, controlled study with a 2-year follow-up. Subjects received either lithium augmentation or the monoamine oxidase inhibitor phenelzine. The primary outcome criterion was remission, defined as a final score of less than or equal to 10 on the Montgomery-Asberg Depression Rating Scale (MADRS). Response was defined as at least 50% reduction on the MADRS or the Hamilton Rating Scale for Depression (HAM-D). RESULTS: Twenty-eight subjects completed the trial. Remission on the MADRS was achieved by 33.3% of the lithium patients, compared with none of the phenelzine patients (p = .042). Response also showed a difference in favor of lithium augmentation (p = .035 on both the MADRS and the HAM-D). Overall tolerability was good, with no dropouts due to side effects. Subjective memory impairment was more prevalent among patients receiving phenelzine (p = .002), and tremors were significantly more prevalent among patients receiving lithium (p = .002). During the 2-year follow-up, 25 patients (86.2%) did achieve remission, particularly on prolonging the lithium treatment (5 patients) or on lithium augmentation to phenelzine (5 patients). CONCLUSION: Lithium was more effective than phenelzine in elderly patients with treatment-resistant major depressive disorder, while tolerance of both treatments was remarkably good in this group of elderly inpatients with many comorbid medical disorders. CLINICAL TRIALS REGISTRATION: Controlled-trials.com identifier is RCTN93105957.
机译：背景：多达三分之一的重度抑郁症老年患者对抗抑郁药的第一疗程无反应。尚缺乏评估晚期抑郁症中抗药性抑郁症的疗法的对照研究，还没有发表评估老年患者锂增强的疗效和耐受性的随机对照研究。方法：根据DSM-IV标准，对先前未能对1项或3项以上三环抗抑郁药或文拉法辛的一项或多项适当试验无效的老年抑郁症住院患者，进行了为期6周，开放，随机，对照的研究。两年的随访。受试者接受锂增强或单胺氧化酶抑制剂苯乙嗪。主要结局指标为缓解，定义为蒙哥马利-阿斯伯格抑郁量表（MADRS）的最终得分小于或等于10。缓解定义为MADRS或汉密尔顿抑郁量表（HAM-D）至少降低50％。结果：28名受试者完成了试验。锂患者中MADRS的缓解率达到33.3％，而苯乙肼患者中均未缓解（p = .042）。响应也显示出有利于锂增强的差异（MADRS和HAM-D上的p均= .035）。总体耐受性良好，无副作用。主观记忆障碍在接受苯乙嗪的患者中更为普遍（p = .002），而震颤在接受锂的患者中更为普遍（p = .002）。在为期2年的随访中，有25名患者（86.2％）确实达到了缓解，尤其是在延长锂疗程（5例）或将锂增加至苯乙嗪（5例）方面。结论：对于患有难治性重度抑郁症的老年患者，锂的疗效优于苯乙嗪，而这组患有多种合并症的老年住院患者的两种疗法的耐受性均显着好。临床试验注册：Controlled-trials.com的标识符为RCTN93105957。

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