性别对舍曲林与丙米嗪治疗慢性抑郁响应率的影响

中国临床药理学与治疗学 ›› 2017, Vol. 22 ›› Issue (10): 1172-1179.

性别对舍曲林与丙米嗪治疗慢性抑郁响应率的影响

方国栋¹, 张丽华², 唐薇婷³

¹中南大学职工医院药剂科，长沙 410083，湖南；²中南大学湘雅医院卫生部纳米生物技术重点实验室，长沙 410087，湖南；³中南大学湘雅医院神经内科，长沙 410087，湖南

收稿日期:2016-12-22 修回日期:2017-04-25 出版日期:2017-10-26 发布日期:2017-11-13
作者简介:方国栋，男，本科，主管药剂师，研究方向：药学。 Tel：13574858095 E-mail:273586270@qq.com

Effects of gender difference on response to sertraline and imipramine in patients with chronic depression

FANG Guodong ¹, ZHANG Lihua², TANG Weiting ³

¹Department of Pharmacy, Staff Hospital of Central South University, Hunan 410083, Changsha, China;² Key laboratory of Nanobiotechnolgy of National Health, ³ Department of Neurology, Xiangya Hospital of Central South University, Hunan 410087, Changsha, China

Received:2016-12-22 Revised:2017-04-25 Online:2017-10-26 Published:2017-11-13

摘要/Abstract

摘要：

目的: 探讨性别差异对选择性5-羟色胺再摄取抑制剂舍曲林和三环类药物丙米嗪治疗慢性抑郁响应率的影响。方法: 于本院就诊的235例男性和400例女性且根据DSM-III-R诊断标准确诊的慢性重性抑郁或双向抑郁患者接受12周舍曲林或丙米嗪双盲治疗。结果: 女性患者对舍曲林的响应率高于丙米嗪，而男性患者对丙米嗪的响应率高于舍曲林；性别和治疗方法对患者退出研究率也有限制影响，接受丙米嗪治疗的女性抑郁患者和接受舍曲林治疗的男性抑郁患者退出研究率更高；性别对丙米嗪的响应时间有影响，女性对丙米嗪的响应时间慢于男性；未绝经女性对舍曲林的响应率优于绝经女性，而绝经女性对两种药物的响应率大致相同。结论: 男性和女性慢性抑郁患者对5-羟色胺再摄取抑制剂和三环类药物丙米嗪的响应率和耐受力有显著差异。未绝经女性对不同药物的响应率也不同。女性性激素加强了5-羟色胺再摄取抑制剂的响应率，而抑制了三环类药物的响应率。因此，抑郁患者选择治疗用药时需考虑性别和月经状态的影响。

关键词: 性别差异, 慢性抑郁, 舍曲林, 丙米嗪

Abstract:

AIM: To examine the gender difference on response to sertraline, a selective serotonin reuptake inhibitor, and to imipramine, a tricyclic antidepressant, for chronic depression. METHODS: A total of 235 male and 400 female outpatients with DSM-III-R chronic major depression or bipolar depression (i.e., major depression superimposed on dysthymia) were randomly assigned to 12 weeks of double-blind treatment with sertraline or with imipramine after placebo washout.RESULTS:Women were significantly more likely to show a favorable response to sertraline than to imipramine, and men were significantly more likely to show a favorable response to imipramine than to sertraline. Gender and type of medication were also significantly related to dropout rates; women who were taking imipramine and men who were taking sertraline were more likely to withdraw from the study. Gender differences in time to response were seen with imipramine, with women responding significantly more slowly than men. Comparison of treatment response rates by menopausal status showed that premenopausal women responded significantly better to sertraline than to imipramine and that postmenopausal women had similar rates of response to the two medications. CONCLUSION: Men and women with chronic depression show differential responsivity and tolerability of SSRIs and tricyclic antidepressants. The differing response rates between the drug classes in women were observed primarily in pre-menopausal women. Thus, female sex hormones may enhance response to SSRIs or inhibit response to tricyclics. Both gender and menopausal status should be considered when choosing an appropriate antidepressant for a depressed patient.

Key words: gender differences, chronic depression, sertraline, imipramine

中图分类号:

R749.05

方国栋, 张丽华, 唐薇婷. 性别对舍曲林与丙米嗪治疗慢性抑郁响应率的影响[J]. 中国临床药理学与治疗学, 2017, 22(10): 1172-1179.

FANG Guodong, ZHANG Lihua, TANG Weiting. Effects of gender difference on response to sertraline and imipramine in patients with chronic depression[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2017, 22(10): 1172-1179.

参考文献

［1］Derry HM, Padin AC, Kuo JL, et al. Sex differences in depression: does inflammation play a role［J］ ? Curr Psychiatry Rep, 2015, 17(10): 78.
［2］赵晓川, 王学义, 金圭星, 等. 不同性别抑郁症患者自杀意念的相关危险因素比较［J］. 神经疾病与精神卫生, 2014, 14(2): 147-149.
［3］Oquendo MA, Ellis SP, Greenwald S, et al. Ethnic and sex differences in suicide rates relative to major depression in the United States［J］. Am J Psychiatry, 2001,158(10):1652-1658.
［4］Khan A, Brodhead AE, Schwartz KA, et al. Sex differences in antidepressant response in recent antidepressant clinical trials［J］. J Clin Psychopharmacol, 2005, 25(4): 318-324.
［5］寻广磊, 李乐华, 赵靖平, 等. 艾司西酞普兰与西酞普兰治疗抑郁症的随机、双盲、双模拟、多中心平行对照研究［J］. 中国新药与临床杂志, 2009, 28(4): 263-267.
［6］王志琴, 尹丽杰, 张丽华. 浅谈雌激素在抑郁症治疗中的作用［J］. 中国农村卫生, 2013,11 (03Z): 207-208.
［7］Parker G, Roy K, Mitchell P, et al. Atypical depression: a reappraisal［J］. Am J Psychiatry, 2002,159(9):1470-1479.
［8］黄洁云. 抑郁症的发病机制与治疗进展［J］. 中国疗养医学, 2013, 22(3): 233-235.
［9］张明园. 抑郁症临床治愈和用药实践问题的提出［J］. 中华精神科杂志, 2013, 46(4): 242.
［10］Celli B, Vestbo J, Jenkins CR, et al. Sex differences in mortality and clinical expressions of patients with chronic obstructive pulmonary disease: the TORCH experience ［J］. Am J Respir Crit Care Med, 2011, 183(3): 317-322.
［11］曹衍淼, 王美萍, 曹丛, 等. 抑郁遗传基础的性别差异［J］. 心理科学进展, 2013, 21(9): 1605-1616.
［12］朱智佩, 张丽, 蒋江灵, 等. 广泛性焦虑障碍认知行为治疗的疗效评估中设置心理治疗安慰剂对照组或等待治疗对照组的比较: 一项 Meta 分析［J］. 上海精神医学, 2014, 26(6): 319-331.
［13］殷敏, 袁茵. 美国最新自闭症谱系障碍诊断标准解析［J］. 中小学心理健康教育, 2014, (91): 07-12.
［14］王纯, 楚艳民, 张亚林, 等. 汉密尔顿焦虑量表的因素结构研究［J］. 临床精神医学杂志, 2011, 21(5): 299-301.
［15］吴文源, 张明园. 临床疗效总评量表 (CGI)［J］. 上海精神医学, 1984, 2(1): 76-77.
［16］王振, 苑成梅, 黄佳, 等. 贝克抑郁量表中文版在抑郁症患者中的信效度［J］. 中国心理卫生杂志, 2011, 25(6): 476-480.
［17］Steiner MA, Marsicano G, Nestler EJ, et al. Antidepressant-like behavioral effects of impaired cannabinoid receptor type 1 signaling coincide with exaggerated corticosterone secretion in mice［J］. Psychoneuroendocrinol, 2008, 33(1): 54-67.
［18］Lewis-hall FC, Wilson MG, Tepner RG, et al. Fluoxetine vs. tricyclic antidepressants in women with major depressive disorder ［J］. J Womens Health, 1997, 6(3): 337-343.
［19］Frank E, Carpenter LL, Kupfer DJ. Sex differences in recurrent depression: are there any that are significant ［J］ ? Am J Psychiatry, 1988, 145(1): 41-45.
［20］Atlantis E, Sullivan T. Bidirectional association between depression and sexual dysfunction: A systematic review and meta analysis ［J］. J Sex Med, 2012, 9(6): 1497-1507.
［21］Thase ME, Frank E, Kornstein SG, et al. Gender differences in response to treatments of depression［J］. Gender Effect Psychopathol, 2000，32(8): 103-129.
［22］王同显, 于瑞宝, 乔显森. 选择性血清素再摄取抑制剂类抗抑郁药物相关出血风险［J］. 中国输血杂志, 2014, 27(4): 448-451.
［23］Kendall DA, Stancel GM, Enna SJ. The influence of sex hormones on antidepressant-induced alterations in neurotransmitter receptor binding ［J］. J Neurosci, 1982, 2(3):354-360.
［24］Halbreich U, Rojansky N, Palter S, et al. Estrogen augments serotonergic activity in postmenopausal women［J］. Biol Psychiatry, 1995, 37(7): 434-441.

[1]	章思亮, 胡琳璘, 邵华, 陈西敬. 性别差异对精神药物作用影响的研究进展[J]. 中国临床药理学与治疗学, 2021, 26(3): 324-331.
[2]	葛薇，盛文燕，许琦彬，李秋实，苏铃雅，吴双庆. 选择性5-羟色胺再摄取抑制剂类抗抑郁药舍曲林对产后抑郁患者眼表功能影响[J]. 中国临床药理学与治疗学, 2020, 25(4): 440-446.
[3]	曹婷，李娜娜，蔡骅琳. 神经甾体在精神分裂症发病与治疗中作用的研究进展[J]. 中国临床药理学与治疗学, 2018, 23(6): 709-714.
[4]	王军青, 陈爱瑛, 董文彬, 程敏, 郑高利. 柠檬苦素在大鼠肝微粒体中代谢的性别差异[J]. 中国临床药理学与治疗学, 2014, 19(2): 156-161.
[5]	汪丽佳, 秦丽娟, 刘丹, 刘任, 周岐新. 大鼠抑郁行为的性别差异与单胺转运体及单胺氧化酶B关系的实验研究[J]. 中国临床药理学与治疗学, 2013, 18(9): 993-998.
[6]	郝彬, 李欣燕, 周向军, 王永祥. HPLC-UV法测定皮肤给药后大鼠血浆5-(4-苯氧丁氧基)补骨脂素浓度[J]. 中国临床药理学与治疗学, 2010, 15(11): 1234-1239.
[7]	王少华, 赵艳, 刘振胜, 闫美兴, 李志平, 艾登斌, 孙立新. 甲磺酸罗哌卡因注射液病人体内药代动力学研究[J]. 中国临床药理学与治疗学, 2009, 14(6): 677-680.
[8]	沈鑫华, 钱敏才, 林敏, 费小聪, 王士良. 度洛西汀和舍曲林治疗抑郁症的对照研究[J]. 中国临床药理学与治疗学, 2009, 14(2): 207-209.
[9]	王晓莉, 谢林, 刘晓东. 大鼠口服尼莫地平吸收动力学性别差异研究[J]. 中国临床药理学与治疗学, 2004, 9(5): 532-535.
[10]	余爱荣, 吴笑春, 李罄, 辛华雯, 仲明远, 谢森. 肾移植受者口服环孢素A 药代动力学的性别差异[J]. 中国临床药理学与治疗学, 2004, 9(2): 220-222.