Henry Chantal, Demotes-Mainard Jacques
Hôpital Charles Perrens, Bâtiment Lescure, 121 rue de la Béchade, 33076 Bordeaux Cedex, France.
Curr Drug Saf. 2006 Jan;1(1):59-62. doi: 10.2174/157488606775252665.
To what extent do SSRIs increase the risk of suicide or violent behavior? Recent data indicate that some SSRIs lack a favorable 'risk-benefit' profile for treating childhood and adolescent depression. In addition, certain recent documents have cast doubt on previous conclusions dissociating antidepressant from violence. Beyond the debate on the need for improved transparency in clinical studies, this controversy raises other critical issues of SSRI use that merit our consideration. Firstly, is there an overuse of antidepressants, and does the risk of suicide increase with the prescription of antidepressants in the whole population? Secondly, is the response to antidepressants modified during adolescence? If so, by what mechanisms? We know that SSRI treatment can trigger mood changes in undiagnosed young bipolar patients resulting in agitation and disinhibition, and such effects may lead to suicide and violence. Thirdly, recent extensive literature has shown that some cases of depression are worsened by antidepressants and new data has suggested that bipolar depression can be improved by atypical antipsychotics. Finally, current criteria defining the depressive state are very similar to those employed during the 19th century, a pre-therapeutic period. Currently, while it is recognised that depressive mood is a very broad construct, there is still only one definition in international classifications to describe a major depressive episode. There is a clear need to develop an evidence-based approach to psychiatry aiming at delineating diagnostic categories predictive of the response to treatments.
选择性5-羟色胺再摄取抑制剂（SSRI）在多大程度上会增加自杀或暴力行为的风险？近期数据表明，某些SSRI在治疗儿童和青少年抑郁症方面缺乏良好的“风险效益”特征。此外，某些近期文件对先前将抗抑郁药与暴力行为区分开来的结论提出了质疑。除了关于临床研究提高透明度必要性的争论之外，这场争议还引发了其他值得我们考虑的SSRI使用关键问题。首先，抗抑郁药是否存在过度使用的情况，在整个人口中，抗抑郁药的处方是否会增加自杀风险？其次，青少年对抗抑郁药的反应是否会发生改变？如果是，通过什么机制？我们知道，SSRI治疗可在未确诊的年轻双相情感障碍患者中引发情绪变化，导致激动和行为失控，而这些影响可能会导致自杀和暴力行为。第三，近期大量文献表明，一些抑郁症病例会因抗抑郁药而恶化，新数据表明非典型抗精神病药物可改善双相抑郁症。最后，目前定义抑郁状态的标准与19世纪（一个治疗前时期）所采用的标准非常相似。目前，虽然人们认识到抑郁情绪是一个非常宽泛的概念，但在国际分类中仍然只有一个定义来描述重度抑郁发作。显然需要制定一种基于证据的精神病学方法，旨在界定可预测治疗反应的诊断类别。
