Mischoulon David
Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, WAC-812, 15 Parkman Street, Boston, MA 02114, USA.
Psychiatr Clin North Am. 2007 Mar;30(1):51-68. doi: 10.1016/j.psc.2006.12.003.
Natural medications such as St. John's Wort, SAMe, and omega-3 fatty acids eventually may prove to be valuable additions to the psychiatrist's pharmacologic armamentarium, both as monotherapy and as adjunctive therapy for mood disorders. Current research data are compelling, from a standpoint of both efficacy and safety, but before clinicians can recommend these as first-line treatments, more well-designed controlled studies in large patient populations are needed. During the past decade, the National Institutes of Health, the National Institute for Mental Health, and the National Center for Complementary and Alternative Medicine have widened their support for research on the efficacy and safety of alternative treatments, and increasing numbers of academic institutions are undertaking large-scale, multicenter studies on the natural medications reviewed here, as well as others. These studies should help answer some of the yet-unsettled questions about natural medications. Psychiatrists who are considering recommending natural antidepressants to their patients should emphasize that these treatments are relatively unproven and that it remains to be seen whether they would be appropriate or preferable to the conventional psychotropic agents. in the absence of more conclusive data, the best candidates for alternative treatments may be patients for whom a delay in adequate treatment would not be devastating(eg, the mildly symptomatic patient who has a strong interest in natural remedies). Other good candidates may include patients who have been unresponsive to conventional antidepressants or particularly intolerant of side effects; these patients, however, often are the most difficult to treat, and alternative agents seem best suited for the mildly ill. Care should be taken with patients who are taking multiple medications, in view of adverse drug-drug interactions that have emerged with increased use of alternative treatments. Finally, as with all psychotropic agents, natural medications should be used preferably under the supervision of a physician.
圣约翰草、S-腺苷甲硫氨酸和ω-3脂肪酸等天然药物最终可能被证明是精神科医生药物库中有价值的补充药物，可作为单一疗法或作为情绪障碍的辅助疗法。从疗效和安全性的角度来看，目前的研究数据很有说服力，但在临床医生能够将这些药物推荐为一线治疗药物之前，还需要在大量患者群体中进行更多精心设计的对照研究。在过去十年中，美国国立卫生研究院、美国国立精神卫生研究所和美国国立补充与替代医学中心扩大了对替代疗法疗效和安全性研究的支持，越来越多的学术机构正在对本文所综述的天然药物以及其他药物进行大规模、多中心研究。这些研究应有助于回答一些关于天然药物尚未解决的问题。考虑向患者推荐天然抗抑郁药的精神科医生应强调，这些治疗方法相对未经证实，它们是否比传统精神药物更合适或更可取还有待观察。在缺乏更确凿数据的情况下，替代疗法的最佳候选者可能是那些延迟充分治疗不会造成严重后果的患者（例如，对天然疗法有浓厚兴趣的轻度症状患者）。其他合适的候选者可能包括对传统抗抑郁药无反应或特别不耐受副作用的患者；然而，这些患者往往是最难治疗的，替代药物似乎最适合病情较轻的患者。鉴于随着替代疗法使用的增加出现了不良药物相互作用，对于正在服用多种药物的患者应谨慎。最后，与所有精神药物一样，天然药物最好在医生的监督下使用。
