Tollefson G D, Lancaster S P, Montague-Clouse J
Department of Psychiatry, St. Paul-Ramsey Medical Center, MN 55101.
Psychopharmacol Bull. 1991;27(2):163-70.
Recent literature has addressed a frequent comorbidity between alcoholism and anxiety/depression. These disorders have been interdigitated with the brain amines serotonin (5-HT) and norepinephrine. We investigated 51 dually diagnosed patients (generalized anxiety disorder with depressive features plus alcohol abuse/dependency) under a randomized, double-blind, placebo-controlled trial employing the 5-HT1A compound buspirone. Buspirone was superior to placebo as an anxiolytic. It was well tolerated and reduced the number of days patients desired alcohol. At the final study dose, the buspirone metabolite 1-pyrimidinylpiperazine (1-PP) was significantly related to improvement in anxiety, global depressive symptoms, and number of days not using alcohol. Analysis using the Hamilton Rating Scale for Depression and its retardation cluster revealed significant improvement secondary to anxiolysis. Thus, buspirone (especially via its 1-PP metabolite) may be an effective treatment strategy in the anxious or mixed anxious-depressive patient with comorbid alcoholism when other conventional anxiolytics may be contraindicated.
近期文献探讨了酒精中毒与焦虑症/抑郁症之间常见的共病情况。这些疾病与脑胺血清素（5-羟色胺，5-HT）和去甲肾上腺素相互关联。我们在一项随机、双盲、安慰剂对照试验中，使用5-HT1A复合制剂丁螺环酮，对51例双重诊断患者（伴有抑郁特征的广泛性焦虑症加酒精滥用/依赖）进行了研究。作为一种抗焦虑药，丁螺环酮优于安慰剂。它耐受性良好，减少了患者对酒精的需求天数。在最终研究剂量下，丁螺环酮的代谢产物1-嘧啶基哌嗪（1-PP）与焦虑改善、总体抑郁症状以及不饮酒天数显著相关。使用汉密尔顿抑郁量表及其迟缓因子进行分析显示，抗焦虑治疗后有显著改善。因此，当其他传统抗焦虑药可能禁忌时，丁螺环酮（尤其是通过其1-PP代谢产物）可能是治疗伴有酒精中毒的焦虑或混合性焦虑抑郁患者的有效治疗策略。
