Martin P
Département de Psychiatrie et de Psychologie Médicale, Unité de recherche, Hôpital St-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris.
Encephale. 2006 Oct;32(5 Pt 1):753-66. doi: 10.1016/s0013-7006(06)76228-5.
The potential for drug-drug interactions in psychiatric patients is very high as combination psychopharmacotherapy used to treat comorbid psychiatric disorders, to treat the adverse effects of a medication, to augment a medication effect or to treat concomitant medical illnesses, etc. Interactions can be pharmacodynamic or pharmacokinetic in nature. In clinical practice the benzodiazepines (BZD) are often prescribed together with antidepressant drugs for the treatment of depression. Although there has been no convincing evidence to show that such a combination is more effective than antidepressants alone and no clear indication for the use of this combination. Yet, anxiety frequently coexists with depression, and an anxiolytic is often added. But, it is BZD which are systematically prescribed together with antidepressants. However, BZD themselves have no antidepressive effects and we lack firm evidence for or against this combination therapy. We are focused on the pharmacodynamic interactions between anxiolytic such as BZD, and antidepressant drugs which may resulting in a reduction of the effects of one of the drugs. It is known that BZD decrease the serotoninergic transmission. Also, it may be suggested that combined BZD-specific serotonin reuptake inhibitors, should be avoided. This paper reviews, in vitro and in vivo and particularly in clinical, the evidences for drug interactions between BZD and antidepressant drugs. In clinical, all trials that compared antidepressant-benzodiazepine treatment with antidepressant alone for adult patients with major depression were sought by electronic searches of Medline and several other databases (1970 to 2005), combined with hand searching, reference searching and SciSearch.
精神科患者发生药物相互作用的可能性非常高，因为联合使用精神药物疗法来治疗共病的精神障碍、治疗药物的不良反应、增强药物疗效或治疗伴随的躯体疾病等。相互作用在性质上可以是药效学的或药代动力学的。在临床实践中，苯二氮䓬类药物（BZD）常与抗抑郁药物联合使用来治疗抑郁症。尽管尚无令人信服的证据表明这种联合用药比单独使用抗抑郁药更有效，且这种联合用药也没有明确的适应证。然而，焦虑常常与抑郁并存，因此常加用一种抗焦虑药。但系统应用的是与抗抑郁药联合使用的BZD。然而，BZD本身并无抗抑郁作用，而且我们缺乏支持或反对这种联合治疗的确切证据。我们关注的是诸如BZD等抗焦虑药与抗抑郁药物之间的药效学相互作用，这可能导致其中一种药物的疗效降低。已知BZD会减少5-羟色胺能传递。此外，可能有人建议应避免联合使用BZD与特异性5-羟色胺再摄取抑制剂。本文综述了BZD与抗抑郁药物之间药物相互作用的体外、体内尤其是临床证据。在临床方面，通过对Medline和其他几个数据库（1970年至2005年）进行电子检索，并结合手工检索、参考文献检索和科学信息检索，查找了所有将抗抑郁药-苯二氮䓬类药物联合治疗与单独使用抗抑郁药治疗成年重度抑郁症患者进行比较的试验。
