Department of Psychiatry, Institut de Neurociències, Hospital Clínic i Provincial de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain,
Curr Treat Options Neurol. 2015 Jan;17(1):323. doi: 10.1007/s11940-014-0323-4.
Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system with a significant comorbidity with depressive disorders. Prevalence rates for major depressive disorder (MDD) range from 36 % to 54 % and the rate is around 22 % for adjustment disorders. Selective serotonin reuptake inhibitors (SSRIs) are considered well-tolerated first-line treatment. Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) are generally reserved for second-line use after SSRIs, because of sedating or anticholinergic side effects. SNRIs, with the exception of duloxetine, and combinations of newer antidepressants have failed to treat depression due to their side effects profile and frequent interaction with other drugs. Among SSRIs, sertraline is usually the first option, starting at 25 mg/day and increasing to 50 mg/day; and waiting a few weeks to assess drug effects before increasing the dose. The maximum is generally 200 mg/day in a single dose. Paroxetine is the second choice, starting at 10 mg/day for the first 5 days, and then at 20 mg/day thereafter. The maximum dose is about 50 mg/day in a single dose. Fluvoxamine is used at 100-200 mg/day, starting with 25 mg/day, and increasing 25 mg/day every 5 days until 200 mg/day is reached. We should take into account increasing blood level amounts of MS treatments (corticosteroids and cyclophosphamide) with fluvoxamine. With duloxetine, doses will be at 60-120 mg/day. The initial dose for depression is 40 mg/day in two doses; it can increase to 60 mg/day in one to two doses if necessary. The maximum dose is generally 120 mg/day. Duloxetine may increase liver problems through interaction with these MS treatments: teriflunomide, interferon beta-1a, and interferon beta-1b. Considering psychotherapy, only cognitive behavior therapy and mindfulness-based interventions have shown efficacy in improving depression disorders in MS. A comprehensive treatment for depression should include pharmacotherapy and psychotherapy.
多发性硬化症（MS）是一种中枢神经系统的慢性脱髓鞘疾病，与抑郁障碍有很大的共病性。重度抑郁症（MDD）的患病率为 36%至 54%，而适应障碍的患病率约为 22%。选择性 5-羟色胺再摄取抑制剂（SSRIs）被认为是耐受良好的一线治疗药物。三环类抗抑郁药（TCAs）和单胺氧化酶抑制剂（MAOIs）通常在 SSRIs 之后作为二线药物保留，因为它们有镇静或抗胆碱能的副作用。SNRIs 除了度洛西汀以外，以及新型抗抑郁药的组合，由于其副作用特征和与其他药物频繁相互作用，未能治疗抑郁症。在 SSRIs 中，舍曲林通常是首选药物，起始剂量为 25mg/天，增加至 50mg/天；在增加剂量之前，等待几周评估药物效果。单剂量一般最大剂量为 200mg/天。帕罗西汀是第二种选择，起始剂量为 10mg/天，前 5 天，然后增加至 20mg/天。单剂量最大剂量约为 50mg/天。氟伏沙明的用量为 100-200mg/天，起始剂量为 25mg/天，每 5 天增加 25mg/天，直至达到 200mg/天。我们应该考虑到氟伏沙明会增加 MS 治疗药物（皮质类固醇和环磷酰胺）的血药水平。对于度洛西汀，剂量将为 60-120mg/天。治疗抑郁症的起始剂量为每天两次 40mg；如果需要，可增加至每天一次或两次 60mg。最大剂量一般为 120mg/天。度洛西汀可能会通过与这些 MS 治疗药物相互作用而增加肝脏问题：特立氟胺、干扰素β-1a 和干扰素β-1b。考虑到心理治疗，只有认知行为疗法和正念干预在改善多发性硬化症患者的抑郁障碍方面显示出疗效。抑郁症的全面治疗应包括药物治疗和心理治疗。
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