Schatzberg A F, Rothschild A J
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Calif. 94305-5490.
J Clin Psychiatry. 1992 Oct;53 Suppl:52-5.
Psychotic (delusional) major depression is a distinct syndrome with marked morbidity. Previous studies have emphasized the role that glucocorticoids and dopamine may play in the pathogenesis of the disorder as well as in its response to treatment. In addition to reviewing data on these two systems, the possible role serotonin (5-HT) may play is also reviewed. Studies indicate increased 5-HT reuptake into platelets and elevated cerebrospinal fluid levels of the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) are found in patients with this disorder. In addition, amoxapine, a four-ringed antidepressant with 5-HT2 antagonistic properties, has been reported to be effective in treating patients with this disorder. The implications of these findings vis-à-vis a role for serotonin in delusional major depression are discussed. Future studies on serotonin as well as on 5-HT2 antagonists in delusional depression are warranted.
精神病性（妄想性）重度抑郁症是一种具有明显发病率的独特综合征。先前的研究强调了糖皮质激素和多巴胺在该疾病发病机制以及治疗反应中可能发挥的作用。除了回顾这两个系统的数据外，还回顾了血清素（5-羟色胺，5-HT）可能发挥的作用。研究表明，该疾病患者血小板中5-HT再摄取增加，脑脊液中血清素代谢物5-羟吲哚乙酸（5-HIAA）水平升高。此外，据报道，具有5-HT2拮抗特性的四环类抗抑郁药阿莫沙平对治疗该疾病患者有效。讨论了这些发现对血清素在妄想性重度抑郁症中作用的影响。有必要对血清素以及妄想性抑郁症中的5-HT2拮抗剂进行进一步研究。
