Shytle R D, Silver A A, Sanberg P R
Department of Psychiatry and Behavioral Medicine, University of South Florida College of Medicine, Tampa, Florida 33613, USA.
Biol Psychiatry. 2000 Nov 15;48(10):1028-31. doi: 10.1016/s0006-3223(00)00945-8.
We have previously proposed that the therapeutic effect of transdermal nicotine in Tourette's syndrome may involve nicotinic receptor inactivation resulting from a prolonged continuous exposure to nicotine. In vitro studies with nicotine and preliminary positive experience with mecamylamine (Inversine), a nicotinic receptor antagonist, in the clinical treatment of Tourette's syndrome patients, further supports the receptor inactivation hypothesis.
We retrospectively documented an unexpected therapeutic response to mecamylamine (2.5-7.5 mg/day) in two Tourette's syndrome patients who were subsequently found to have comorbid bipolar disorder as defined by DSM-IV criteria.
In patient 1, the mood-stabilizing effect of mecamylamine was noticed by the patient during the course of mecamylamine treatment and brought to our attention, whereas for patient 2, manic symptoms were only apparent clinically following cessation of mecamylamine treatment.
The clinical observations presented here suggest that nicotinic antagonists might be potential therapeutic agents for the treatment of bipolar disorder. Double-blind, placebo-controlled studies are now necessary to investigate these observations under more rigorous conditions.
我们之前曾提出，透皮尼古丁在治疗抽动秽语综合征中的疗效可能涉及因长时间持续接触尼古丁导致的烟碱型受体失活。尼古丁的体外研究以及烟碱型受体拮抗剂美加明（安血定）在抽动秽语综合征患者临床治疗中的初步积极经验，进一步支持了受体失活假说。
我们回顾性记录了两名抽动秽语综合征患者对美加明（2.5 - 7.5毫克/天）出现的意外治疗反应，这两名患者随后被发现符合DSM - IV标准定义的双相情感障碍共病。
在患者1中，患者在美加明治疗过程中注意到了美加明的情绪稳定作用，并引起了我们的注意，而对于患者2，躁狂症状仅在美加明治疗停止后才在临床上显现出来。
此处呈现的临床观察结果表明，烟碱型拮抗剂可能是治疗双相情感障碍的潜在治疗药物。现在需要进行双盲、安慰剂对照研究，以便在更严格的条件下研究这些观察结果。
