Sansone Randy A, Sansone Lori A
Departments of Psychiatry and Internal Medicine, Wright State University School of Medicine, Dayton, Ohio, USA.
Innov Clin Neurosci. 2011 Jun;8(6):10-4.
Obsessive compulsive disorder can be a challenging psychiatric phenomenon to diagnose and treat. At the present time, recommended treatment strategies include cognitive behavioral therapy (e.g., exposure and response prevention) and pharmacotherapy (e.g., selective serotonin reuptake inhibitors and clomipramine). Unfortunately, even with adequate pharmacotherapy, only 70 percent of patients improve, indicating the clinical need for pharmacological alternatives. Such alternatives may presently exist in the group of antidepressants classified as serotonin-norepinephrine reuptake inhibitors. Although large, double-blind, placebo-controlled studies are lacking, preliminary evidence through case reports and small studies suggests potential efficacy for three currently available serotonin-norepinephrine reuptake inhibitors (e.g., venlafaxine, duloxetine, milnacipran). If genuinely efficacious, serotonin-norepinephrine reuptake inhibitors would be likely to have fewer side effects than clomipramine and might be a reasonable second-line alternative to selective serotonin reuptake inhibitors. Only further research will clarify the role of serotonin-norepinephrine reuptake inhibitors in the treatment of obsessive compulsive disorder.
强迫症是一种在诊断和治疗方面颇具挑战性的精神现象。目前，推荐的治疗策略包括认知行为疗法（如暴露与反应阻止法）和药物疗法（如选择性5-羟色胺再摄取抑制剂和氯米帕明）。遗憾的是，即便进行了充分的药物治疗，也仅有70%的患者病情有所改善，这表明临床上需要其他药物选择。此类替代药物目前可能存在于归类为5-羟色胺-去甲肾上腺素再摄取抑制剂的抗抑郁药组中。尽管缺乏大规模、双盲、安慰剂对照研究，但通过病例报告和小型研究获得的初步证据表明，三种目前可用的5-羟色胺-去甲肾上腺素再摄取抑制剂（如文拉法辛、度洛西汀、米那普明）具有潜在疗效。如果确实有效，5-羟色胺-去甲肾上腺素再摄取抑制剂可能比氯米帕明副作用更少，并且可能成为选择性5-羟色胺再摄取抑制剂合理的二线替代药物。只有进一步的研究才能阐明5-羟色胺-去甲肾上腺素再摄取抑制剂在强迫症治疗中的作用。
