Neurology：抗抑郁新药对帕金森氏症患者是安全的

星期三，4月11日（每日健康新闻）报道，近来研究人员发现一些较新的抗抑郁药可以帮助治疗帕金森氏病患者的抑郁症，不会加重帕金森氏病的其他症状如震颤或等。

近1亿美国人患帕金森氏症。帕金森氏症和抑郁症往往同时发生，以往认为一些用于治疗抑郁症的药物可能会加剧帕金森氏症。

4月17日的Neurology杂志上刊登的一则研究证实情况并非如此，至少抗抑郁药帕罗西汀（帕罗西汀）和Effexor（文拉法辛）并不会加剧帕金森氏症病情。

Paxil是一个SNRI类（5-羟色胺和去甲肾上腺素再摄取抑制剂）药物，Effexor是SSRIs类（选择性血清素再摄取抑制剂）类药物。

在这项新的研究中，共有115名帕金森氏症患者参与，参试者给予帕罗西汀、Effexor或无效的“安慰剂”药丸。研究人员随后对患者追访研究12周，结果发现两种抗抑郁药改善了抑郁症症状，同时又没恶化其他一些与疾病相关的症状。

服用帕罗西汀的人平均有59％的患者抑郁症得到改善，服用Effexor的患者有52％得到改善。而服用安慰剂的患者只有32％的人得到改善。

研究者指出，这些药物并不会导致帕金森氏病任何运动症状的恶化。使用抗抑郁药不会提高研究参试者的焦虑水平或整体健康相关生活质量。

根据该报告称：睡眠问题是抗抑郁药最常见的副作用。此外Paxil会增加体重，Effexor会增加患者坐姿时的血压。

纽约州罗切斯特市罗切斯特大学医学中心大学的神经学家、研究项目负责人Irene Hegeman Richard说：抑郁症是影响帕金森氏症患者生活质量的头号负面因素。但这项研究给我们带来了好消息，即帕金森氏症患者的抑郁症是可以治愈的。当治疗患者抑郁症时，患者许多其他症状变得更加容易控制。

卫生部/国家神经紊乱和中风研究所和约翰斯·霍普金斯大学医学院的美国国家研究院资助研究。惠氏制药公司提供Effexor XR和安慰剂，而葛兰素史克公司提供帕罗西汀。（生物谷：Bioon.com）

doi:10.1212/WNL.0b013e3182516244
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A randomized, double-blind, placebo-controlled trial of antidepressants in Parkinson disease

I.H. Richard, MD, M.P. McDermott, PhD, R. Kurlan, MD, J.M. Lyness, MD, P.G. Como, PhD, N. Pearson, RN, MS, S.A. Factor, DO, J. Juncos, MD, C. Serrano Ramos, MD, M. Brodsky, MD, C. Manning, PhD, et al.

Objective: To evaluate the efficacy and safety of a selective serotonin reuptake inhibitor (SSRI) and a serotonin and norepinephrine reuptake inhibitor (SNRI) in the treatment of depression in Parkinson disease (PD).

Methods: A total of 115 subjects with PD were enrolled at 20 sites. Subjects were randomized to receive an SSRI (paroxetine; n = 42), an SNRI (venlafaxine extended release [XR]; n = 34), or placebo (n = 39). Subjects met DSM-IV criteria for a depressive disorder, or operationally defined subsyndromal depression, and scored >12 on the first 17 items of the Hamilton Rating Scale for Depression (HAM-D). Subjects were followed for 12 weeks (6-week dosage adjustment, 6-week maintenance). Maximum daily dosages were 40 mg for paroxetine and 225 mg for venlafaxine XR. The primary outcome measure was change in the HAM-D score from baseline to week 12.

Results: Treatment effects (relative to placebo), expressed as mean 12-week reductions in HAM-D score, were 6.2 points (97.5% confidence interval [CI] 2.2 to 10.3, p = 0.0007) in the paroxetine group and 4.2 points (97.5% CI 0.1 to 8.4, p = 0.02) in the venlafaxine XR group. No treatment effects were seen on motor function.

Conclusions: Both paroxetine and venlafaxine XR significantly improved depression in subjects with PD. Both medications were generally safe and well tolerated and did not worsen motor function.

Classification of Evidence: This study provides Class I evidence that paroxetine and venlafaxine XR are effective in treating depression in patients with PD.