Danileviciūte Vita, Sveikata Audrius
Clinic of Psychiatry, Vilnius University, State Center of Mental Health,Vasaros 5, Lithuania.
Medicina (Kaunas). 2002;38(12):1147-56.
Depression is the most common illness that affects a large number of individuals in all countries. Recent evidence suggest that depressive episodes if left untreated may heighten severity of subsequent episodes and may increase need for more health care resources. The first antidepressants, tricyclics and monoamine oxidase inhibitors, became available in the late 1950s. A progressive tightening of requirements by drug licensing authorities has ensured that efficacy evidence is good for most antidepressants that are in use. Contemporary antidepressant classification system is based on the mechanism of action, which is presumed to be responsible for their antidepressant effects. A pharmacodynamic system of classification has advantages because it incorporates the current theories of disease pathophysiology. Understanding the basic aspects of mechanism of action of antidepressants is important for treatment of depressive episode, for development of augmenting strategies and combining antidepressants with other antidepressants or antipsychotics. Antidepressants as a class of psychotropic medication have the broad range of indications. The choice of initial antidepressant legitimately varies considerably among clinicians and countries. Referring to some differences of recommendations for the first line treatment of depressive episode we suppose that the choice of antidepressant medication must be individualized for a particular patient. Novel antidepressants (SSRI, SNRI, NaSSA, NARI, NDRI and other) are safe and better tolerated. Metabolism of novel antidepressants is much improved compared with MAOIs and TCAs. The combination of antidepressants is an important clinical issue. There are the following principles of combining antidepressants: 1. to combine mechanisms of action not just drugs, 2. to combine antidepressants and to promote pharmacological synergy and tolerability, 3. to use important synergies within the serotonin, noradrenaline and even dopamine monoaminergic systems. Adequate treatment of depression including modern treatment approaches has the potential to reduce suffering and disability substantially and minimise the risk of suicide.
抑郁症是影响所有国家众多人群的最常见疾病。最近的证据表明，抑郁发作若不治疗，可能会加重后续发作的严重程度，并可能增加对更多医疗资源的需求。首批抗抑郁药，即三环类药物和单胺氧化酶抑制剂，于20世纪50年代末问世。药品许可当局对要求的逐步严格确保了大多数正在使用的抗抑郁药都有充分的疗效证据。当代抗抑郁药分类系统基于作用机制，该机制被认为是其抗抑郁作用的原因。基于药效学的分类系统具有优势，因为它纳入了当前的疾病病理生理学理论。了解抗抑郁药作用机制的基本方面对于治疗抑郁发作、制定增效策略以及将抗抑郁药与其他抗抑郁药或抗精神病药联合使用都很重要。抗抑郁药作为一类精神药物有广泛的适应证。临床医生和不同国家之间，初始抗抑郁药的选择差异相当大。参考关于抑郁发作一线治疗的一些推荐差异，我们认为抗抑郁药的选择必须针对特定患者进行个体化。新型抗抑郁药（选择性5-羟色胺再摄取抑制剂、5-羟色胺-去甲肾上腺素再摄取抑制剂、去甲肾上腺素能及特异性5-羟色胺能抗抑郁药、去甲肾上腺素再摄取抑制剂、去甲肾上腺素-多巴胺再摄取抑制剂等）安全且耐受性更好。与单胺氧化酶抑制剂和三环类药物相比，新型抗抑郁药的代谢有了很大改善。抗抑郁药的联合使用是一个重要的临床问题。抗抑郁药联合使用有以下原则：1. 联合作用机制而非仅仅联合药物；2. 联合抗抑郁药以促进药理协同作用和耐受性；3. 在5-羟色胺、去甲肾上腺素甚至多巴胺单胺能系统内利用重要的协同作用。包括现代治疗方法在内的充分的抑郁症治疗有可能大幅减轻痛苦和残疾，并将自杀风险降至最低。
