Jaffe Robert J, Novakovic Vladan, Peselow Eric D
Department of Psychiatry, Mount Sinai School of Medicine, New York, NY 10029, USA.
Clin Neuropharmacol. 2013 Jan-Feb;36(1):24-6. doi: 10.1097/WNF.0b013e318278b703.
The cholinergic-adrenergic hypothesis of mania and depression states that depression is characterized by an increase in central cholinergic activity relative to noradrenergic tone. Scopolamine is a centrally acting competitive inhibitor of the muscarinic cholinergic receptor site. This review seeks to find all available data investigating scopolamine as an antidepressant.
A systematic review of all the published and unpublished or ongoing literature was conducted via Ovid MEDLINE. Keywords used for the search were "scopolamine hydrobromide" in association with one of the following: "depression," "antidepressive agents," "depressive disorder," "depression, chemical," and "affect." PubMed was also searched using "scopolamine" (all fields) and "antidepressant" (all fields) or "depression" (all fields).
A small study with elderly patients failed to show a statistically significant improvement in depression when measured at 120 minutes after infusion. A second small, well-controlled study using intramuscular scopolamine showed a small but statistically significant improvement in depression on the morning after the second dose was received. Two double-blind randomized placebo-controlled crossover trials with intravenous scopolamine 4.0 μg/kg infusions showed a significant improvement in depressive symptoms seen as soon as 3 days after the first treatment. Further data analyses showed a greater antidepressant effect in women, significant improvements in bipolar depression, and 85% success rates predicting who will respond to treatment.
Scopolamine is an effective and rapid antidepressant in both unipolar and bipolar depression, working as quickly as 3 days after initial infusion. Independent replication would greatly enhance the literature.
关于躁狂和抑郁的胆碱能-肾上腺素能假说指出，抑郁的特征是相对于去甲肾上腺素能张力而言，中枢胆碱能活性增加。东莨菪碱是一种作用于中枢的毒蕈碱型胆碱能受体部位的竞争性抑制剂。本综述旨在查找所有研究东莨菪碱作为抗抑郁药的现有数据。
通过Ovid MEDLINE对所有已发表、未发表或正在进行的文献进行系统综述。搜索所用关键词为“氢溴酸东莨菪碱”，并与以下之一相关联：“抑郁”“抗抑郁药”“抑郁症”“化学性抑郁”和“情感”。还使用“东莨菪碱”（所有字段）和“抗抑郁药”（所有字段）或“抑郁”（所有字段）在PubMed中进行搜索。
一项针对老年患者的小型研究未能显示在输注后120分钟测量时抑郁有统计学上的显著改善。另一项使用肌肉注射东莨菪碱的小型、严格对照研究显示，在接受第二剂后的早晨，抑郁有轻微但统计学上的显著改善。两项关于静脉注射4.0μg/kg东莨菪碱的双盲随机安慰剂对照交叉试验显示，在首次治疗后3天就出现了抑郁症状的显著改善。进一步的数据分析显示，女性的抗抑郁效果更佳，双相抑郁有显著改善，且预测谁会对治疗有反应的成功率达85%。
东莨菪碱在单相和双相抑郁中都是一种有效且起效迅速的抗抑郁药，在首次输注后3天即可起效。独立重复研究将极大地充实相关文献。
