Van Oudenhove Lukas, Tack Jan
University Hospital Leuven, and Department of Pathophysiology, Gastroenterology Section, University of Leuven, Herestraat 49, Leuven, Belgium.
Nat Clin Pract Gastroenterol Hepatol. 2009 Feb;6(2):74-5. doi: 10.1038/ncpgasthep1334. Epub 2008 Dec 17.
Several studies have suggested that antidepressants might be beneficial in the treatment of patients with functional gastrointestinal disorders. This commentary discusses the results of a high-quality, multicenter, randomized, double-blind, placebo-controlled trial that showed no benefit of the antidepressant venlafaxine over placebo in the treatment of a large group of patients with functional dyspepsia. Moreover, venlafaxine was poorly tolerated by a considerable number of patients. The routine use of venlafaxine and other serotonin and norepinephrine reuptake-inhibitor antidepressants to treat patients with functional dyspepsia is, therefore, not recommended. Whether certain subgroups of patients, particularly those with anxious or depressive psychiatric comorbidities, might benefit from treatment with this class of antidepressants, however, remains to be elucidated. Antidepressants with different mechanisms of actions, for example mirtazapine, might still prove beneficial for the treatment of functional dyspepsia, but no clinical studies have yet investigated the efficacy of these drugs in this setting.
多项研究表明，抗抑郁药可能对功能性胃肠疾病患者的治疗有益。本评论讨论了一项高质量、多中心、随机、双盲、安慰剂对照试验的结果，该试验表明，在治疗一大群功能性消化不良患者时，抗抑郁药文拉法辛并不比安慰剂更有效。此外，相当多的患者对文拉法辛耐受性较差。因此，不建议常规使用文拉法辛和其他5-羟色胺及去甲肾上腺素再摄取抑制剂类抗抑郁药来治疗功能性消化不良患者。然而，某些亚组患者，特别是那些伴有焦虑或抑郁精神共病的患者，是否可能从这类抗抑郁药治疗中获益，仍有待阐明。作用机制不同的抗抑郁药，如米氮平，可能仍被证明对功能性消化不良的治疗有益，但尚无临床研究调查过这些药物在此情况下的疗效。
