Brunello N, Mendlewicz J, Kasper S, Leonard B, Montgomery S, Nelson J, Paykel E, Versiani M, Racagni G
Department of Pharmaceutical Sciences, University of Modena and Reggio Emilia, Modena, Italy.
Eur Neuropsychopharmacol. 2002 Oct;12(5):461-75. doi: 10.1016/s0924-977x(02)00057-3.
Depression is a common disorder that impacts on all aspects of a person's life. For the past 10 years, clinicians have focused on serotonin in their treatment of depression. This is largely due to the growing acceptance of the efficacy and safety of the selective serotonin reuptake inhibitors (SSRIs) in comparison with older tricyclic antidepressants (TCAs). However, evidence for a role of noradrenaline in depression has been accumulating for some time, beginning with the discovery that drugs which either caused or alleviated depression acted to alter noradrenaline metabolism. Until recently, the role of noradrenaline in depression was predicted from clinical experience with noradrenergic TCAs (desipramine, nortriptyline and protriptyline) and selective serotonin and noradrenaline reuptake inhibitors (venlafaxine, milnacipran). The licensing of reboxetine, a selective noradrenaline reuptake inhibitor now allows the role of noradrenaline in depression to be investigated directly. This review presents key data from the literature that support a role for noradrenaline in depression taking into account neurophysiology, psychopharmacology and clinical trial data.
抑郁症是一种常见的疾病，会影响人的生活方方面面。在过去10年里，临床医生在治疗抑郁症时主要关注血清素。这很大程度上是因为与较老的三环类抗抑郁药（TCAs）相比，选择性血清素再摄取抑制剂（SSRIs）的疗效和安全性越来越被认可。然而，去甲肾上腺素在抑郁症中作用的证据已经积累了一段时间，始于发现那些导致或缓解抑郁症的药物会改变去甲肾上腺素的代谢。直到最近，去甲肾上腺素在抑郁症中的作用是根据去甲肾上腺素能三环类抗抑郁药（地昔帕明、去甲替林和普罗替林）以及选择性血清素和去甲肾上腺素再摄取抑制剂（文拉法辛、米氮平）的临床经验推断出来的。选择性去甲肾上腺素再摄取抑制剂瑞波西汀的获批，现在使得可以直接研究去甲肾上腺素在抑郁症中的作用。这篇综述展示了文献中的关键数据，这些数据从神经生理学、精神药理学和临床试验数据等方面支持了去甲肾上腺素在抑郁症中的作用。
