Montgomery S A, Judge R
Imperial College of Medicine, St Mary's Hospital, London, UK.
Acta Psychiatr Scand Suppl. 2000;403:9-16. doi: 10.1111/j.1600-0447.2000.tb10943.x.
Evidence indicates that alleviating anxiety symptoms early in the treatment of depression improves treatment compliance, limits treatment discontinuations and contributes to a positive treatment outcome. Because of their sedating effects, the tricyclic antidepressants (TCAs) have historically been the first-choice agent in treating comorbid depression and anxiety. However, a growing body of evidence suggests that the selective serotonin reuptake inhibitors (SSRIs) can also be suitable therapy.
We reviewed literature regarding the use of TCAs and SSRIs in depressed patients with comorbid anxiety.
SSRIs are at least as effective as TCAs in the treatment of both overall depression as well as anxiety symptoms. TCAs can cause significant and sometimes unacceptable side effects which limit their therapeutic potential. SSRIs, on the other hand, have little or no effect on cholinergic, histaminergic or adrenergic receptors, and have a very favourable tolerability profile.
The traditional selection of antidepressants based on the presence or absence of anxiety has little scientific support. In considering the overall risk:benefit ratio, SSRIs should be the first line treatment for depression with associated anxiety.
有证据表明，在抑郁症治疗早期缓解焦虑症状可提高治疗依从性，减少治疗中断，并有助于取得积极的治疗效果。由于具有镇静作用，三环类抗抑郁药（TCA）历来是治疗合并抑郁症和焦虑症的首选药物。然而，越来越多的证据表明，选择性5-羟色胺再摄取抑制剂（SSRI）也是合适的治疗方法。
我们回顾了有关TCA和SSRI在合并焦虑症的抑郁症患者中应用的文献。
SSRI在治疗总体抑郁以及焦虑症状方面至少与TCA一样有效。TCA可引起显著且有时难以接受的副作用，这限制了它们的治疗潜力。另一方面，SSRI对胆碱能、组胺能或肾上腺素能受体几乎没有影响，且耐受性良好。
基于是否存在焦虑来传统选择抗抑郁药缺乏科学依据。考虑到总体风险效益比，SSRI应作为伴有焦虑症的抑郁症的一线治疗药物。
