Lader Malcolm
PO Box 56, Institute of Psychiatry, Denmark Hill, London SE5 8AF, United Kingdom.
Eur Neuropsychopharmacol. 2007 Dec;17(12):743-55. doi: 10.1016/j.euroneuro.2007.05.004. Epub 2007 Jul 10.
The proportion of diagnosed depressives prescribed antidepressants has increased markedly over the last 20 years, mainly following the introduction of the selective serotonin reuptake inhibitors. However, currently available antidepressants have notable limitations, relating to their only moderate efficacy relative to placebo, relatively slow onset of action, possible withdrawal symptoms, and problems of compliance. Sleep disturbances are often used to identify newly presenting depressive patients, and may be part of a more general alteration of bodily rhythms. There are links between pharmacological treatments and circadian rhythms in depression, which might represent another, new option for the development of a therapeutic approach to depression treatment. Many antidepressants affect sleep, some are sedative, and others have been used specifically in severely insomniac depressives. Disturbances in circadian rhythms may be an integral part of depressive mechanisms, and normalising them via an innovative mechanism of antidepressant action may be a fruitful avenue in the search for improved antidepressant agents.
在过去20年中，被诊断为抑郁症并开具抗抑郁药的患者比例显著增加，这主要是在选择性5-羟色胺再摄取抑制剂问世之后。然而，目前可用的抗抑郁药存在显著局限性，包括相对于安慰剂其疗效仅为中等、起效相对较慢、可能出现撤药症状以及依从性问题。睡眠障碍常被用于识别新出现的抑郁症患者，并且可能是身体节律更普遍改变的一部分。抑郁症的药物治疗与昼夜节律之间存在联系，这可能代表着抑郁症治疗方法发展的另一种新选择。许多抗抑郁药会影响睡眠，有些具有镇静作用，而其他一些则专门用于严重失眠的抑郁症患者。昼夜节律紊乱可能是抑郁机制的一个组成部分，通过创新的抗抑郁作用机制使其正常化可能是寻找改进抗抑郁药的一条富有成效的途径。
