Posternak Michael A, Zimmerman Mark
Department of Psychiatry and Human Behavior, Brown University School of Medicine, Rhode Island Hospital, Providence, 02905, USA.
J Clin Psychiatry. 2005 Jun;66(6):705-7. doi: 10.4088/jcp.v66n0605.
The notion that selective serotonin reuptake inhibitors (SSRIs) may be associated with higher relapse rates than other antidepressants during maintenance treatment (tachyphylaxis) has been discussed for years, but to date there is little or no empirical evidence confirming this phenomenon. In this study, we systematically assessed prior anti-depressant treatment history in a cohort of depressed patients who presented for outpatient psychiatric treatment. Rates of tachyphylaxis were compared in venlafaxine and tricyclic antidepressants (TCAs), which act as dual reuptake inhibitors, versus SSRIs.
237 patients who presented for treatment at the Rhode Island Hospital Department of Psychiatry's outpatient practice and were diagnosed with DSM-IV major depressive disorder were interviewed with the semistructured Treatment Response to Antidepressant Questionnaire. This cohort reported having undergone 326 prior SSRI trials, 47 prior venlafaxine trials, and 35 prior trials with a TCA. Rates of tachyphylaxis as a function of antidepressant class were compared.
Rates of tachyphylaxis were significantly lower (chi(2) = 6.77, df = 1, p = .01) with the dual reuptake inhibitors venlafaxine and TCAs (3 [3.7%] of 82) compared to rates of tachyphylaxis with SSRIs (46 [14.1%] of 326).
These results provide preliminary evidence that dual reuptake inhibitors may incur lower rates of tachyphylaxis than SSRIs. By virtue of the retrospective and non-random design of the study, these results warrant confirmation.
关于选择性5-羟色胺再摄取抑制剂（SSRIs）在维持治疗期间（快速减敏反应）可能比其他抗抑郁药有更高复发率的观点已讨论多年，但迄今为止几乎没有实证证据证实这一现象。在本研究中，我们系统评估了一组前来接受门诊精神科治疗的抑郁症患者之前的抗抑郁治疗史。比较了作为双重再摄取抑制剂的文拉法辛和三环类抗抑郁药（TCAs）与SSRIs的快速减敏反应发生率。
对罗德岛医院精神科门诊前来治疗且被诊断为DSM-IV重度抑郁症的237名患者进行半结构化抗抑郁药治疗反应问卷调查。该队列报告之前进行过326次SSRI试验、47次文拉法辛试验和35次TCA试验。比较了作为抗抑郁药类别函数的快速减敏反应发生率。
与SSRIs的快速减敏反应发生率（326次中有46次[14.1%]）相比，双重再摄取抑制剂文拉法辛和TCAs的快速减敏反应发生率显著更低（χ² = 6.77，自由度 = 1，p = 0.01）（82次中有3次[3.7%]）。
这些结果提供了初步证据，表明双重再摄取抑制剂可能比SSRIs引起更低的快速减敏反应发生率。鉴于本研究的回顾性和非随机设计，这些结果有待证实。
