目的:对双相和单相抑郁障碍并存焦虑、失眠症状的患者,在应用抗抑郁药治疗的对照研究时,加用苯二氮(艹卓)类药物进行疗效和不良反应观察.方法:将双相和单相抑郁障碍患者各32例,再随机分为文拉法辛合并小剂量舒必利治疗组(合用组)及单用文拉法辛治疗组(对照组),治疗6周.期间对人组治疗前即有焦虑、失眠症状者加用阿普唑仑或氯硝西泮,然后分别在治疗前后用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA),匹兹堡睡眠质量指数(PSQI),和治疗中出现的症状量表(TESS)进行疗效和不良反应评定.结果:双相和单相抑郁患者不但抑郁症状明显改善,而且均未发生明显转躁,焦虑和失眠症状也有明显改善.HAMD、HAMA和PSQI的评分均有明显降低(P<0.001).但治疗过程中,不论双相合用组,还是单相合用组,均在连续并用苯二氮(艹卓)类药物4周后,难以减少该类药物用量或停药.结论:双相和单相抑郁患者用文拉法辛并小量舒必利或者单用文拉法辛治疗时,如伴有明显焦虑、失眠,可并用苯二氮(艹卓)类药物以争取更好疗效.%Objective:To compare the effects of antidepressant and benzodiazepines (BZ) in treating bipolar or unipolar depressive patients with anxious or insomnia symptoms. Method: Thirty two patients with bipolar depressive disorder and 32 patients with unipolar depressive disorder were randomly divided into the experimental group treated by venlafaxine and sulpiride and the control group treated by veulafaxine alone for 6 weeks. Because of coexisting anxious and insomnia symptoms, all the patients were also administered with alprazolm or clonazepam during the trial period. The patients were evaluated using symptom rating scales such as Hamilton depression rating scale( HAMD), Hamilton anxiety rating scale( HAMA), Pittsburgh sleep quality index(PSQI) ,and treatment emergent symptoms scale (TESS) before and after treatment. Results:The total scores of HAMD, HAMA,and PSQI significantly decreased( P ＜ 0.001 ) at the end of the trial in both groups. And there was no significant turning manic symptoms due to using of antidepressant. However, it was difficult to cut down the BZ use in the experimental group. Conclusion: The combination treatment of antidepressants and benzodiazepines could be effective for both unipolar depression and bipolar depression patients with anxious and insomnia symptoms.
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