大うつ病性障害の診断基準を満たさない抑うつ状態を伴う全般性不安障害に対するデュロキセチンの効果―20名の症例検討

Effect of Duloxetine on Outpatients with Generalized Anxiety Disorder with Depressive States Not Meeting the Criteria for Major Depressive Disorder: A case series

抄録

　今回我々は，DSM-Ⅳ-TRの大うつ病性障害の診断基準を満たさない程度の抑うつ状態を伴う全般性不安障害の20名に対し，デュロキセチン（DLX）を投与し，その効果をHamilton Rating Scales for Anxiety（以下，HAM-A）とHamilton Rating Scales for Depression（以下，HAM-D）を評価尺度として用い，DLX投与24週後まで経時的に評価した。また，支持・共感を主とする小精神療法（笠原）と精神障害に対する心理教育を行った。その結果，DLX投与前のHAM-A，HAM-Dに対しDLX投与8週後から統計学的に有意な減少を認め，DLX投与24週後には寛解と判断できるスコア（HAM-A＝5.3±1.9点，HAM-D＝4.8±1.6点）にまで減少した。また，初期投与量のDLXで寛解した症例が4例存在したところから，小精神療法と心理教育が薬物療法に相乗的な効果をもたらしたと推察した。

　The aim of the present 24-week open-label trial was to investigate the effects of duloxetine on 20 outpatients with generalized anxiety disorder with depressive states not meeting the criteria for major depression, as defined by the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (Text Revision). The effects of duloxetine were measured using the Hamilton Rating Scales for Anxiety (HAM-A) and Hamilton Rating Scales for Depression (HAM-D). Duloxetine was initiated at 20mg/day, and the dose was adjusted up to a maximum of 60mg/day depending on patients' clinical condition. Data were analyzed using an intention-to-treat methodology. A repeated-measures analysis of variance was used to compare HAM-A and HAM-D scores at baseline (prior to initiation of duloxetine) and those 4, 8, 12, and 24 weeks after starting duloxetine. Post-hoc testing with Bonferroni/Dunn correction for multiple comparisons was used to compare baseline conditions with each of the follow-up weeks. Subjects were simultaneously treated with psychotherapy consisted of eight suggestions taken notice of consulting function in human relations proposed by Kasahara, during which clinicians worked to understand subjects' worries and sympathize with their distress. Psychotherapy also included psycho-education, with a goal of increasing subjects' awareness of mental disorders. As a result, mean (±standard deviation) baseline scores for both HAM-A (21.2±3.7) and HAM-D (12.5±2.6) decreased significantly, to 10.6±4.1 and 7.6±2.8, respectively, 8 weeks after starting administration of duloxetine. This significant reduction was sustained until 24 weeks, at which time, mean HAM-A and HAM-D scores were 5.3±1.9 and 4.8±1.6, respectively, indicating full remission. These results suggest that duloxetine may be useful for patients with generalized anxiety disorder with depressive states. However, since four patients achieved full remission with the administration of duloxetine at 20mg/day (i.e., the first oral dose level), psychotherapy and psycho-education may have compensated for pharmacotherapy, with the multiplier effect of these treatments allowing patients to achieve full remission.