Jaracz Jan, Rybakowski Janusz
Klinika Psychiatrii Dorosłych Akademii Medycznej w Poznaniu.
Psychiatr Pol. 2005 Sep-Oct;39(5):937-50.
Epidemiological studies confirm frequent appearance of pain symptoms in depressive patients and a marked prevalence of depression in pain conditions. These observations seem to point at a close intertwining between mood regulation and pain perception. In the pathogenesis of both depression and pain symptoms, an important role has been attributed to disturbances of serotonergic and noradrenergic neurotransmission as well as to neuropeptides such as opioids and substance P. In mood regulation as well as in the perception and emotional dimension of pain stimuli, such brain structures as the amygdala, anterior cingulate cortex and prefrontal cortex are of main significance. The action of antidepressant drugs results in a normalization of the activity of those neurotransmitter systems and brain structures. It was found that dual action antidepressants (i.e. influencing both serotonergic and noradrenergic system) such as tricyclic antidepressants and new generation drugs (venlafaxine, milnacipram, duloxetine, mirtazapine) exert a stronger antidepressant effect and possess a broader therapeutic spectrum, including also an effect on pain symptoms. These drugs have been also increasingly used for the treatment of pain symptoms in somatic illnesses (e.g. diabetic neuropathy, fibromyalgia).
流行病学研究证实，抑郁患者经常出现疼痛症状，而在疼痛病症中抑郁症的患病率也显著较高。这些观察结果似乎表明情绪调节与疼痛感知之间存在紧密的相互联系。在抑郁症和疼痛症状的发病机制中，血清素能和去甲肾上腺素能神经传递的紊乱以及阿片类物质和P物质等神经肽都被认为起着重要作用。在情绪调节以及疼痛刺激的感知和情感层面，杏仁核、前扣带回皮质和前额叶皮质等脑结构具有主要意义。抗抑郁药物的作用会使这些神经递质系统和脑结构的活动恢复正常。研究发现，三环类抗抑郁药和新一代药物（文拉法辛、米氮平、度洛西汀、米氮平）等双重作用抗抑郁药（即同时影响血清素能和去甲肾上腺素能系统）具有更强的抗抑郁作用，且治疗范围更广，包括对疼痛症状也有效果。这些药物也越来越多地用于治疗躯体疾病中的疼痛症状（如糖尿病性神经病变、纤维肌痛）。
