Davidson Jonathan
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA
J Psychopharmacol. 2015 Mar;29(3):264-9. doi: 10.1177/0269881114565143. Epub 2015 Jan 13.
Serotonin (SSRI) and serotonin-norepinephrine (SNRI) reuptake inhibitors (SSRI) are the first-line recommended drug treatments for post-traumatic stress disorder (PTSD); but despite their benefits, much residual pathology remains and no new drugs have yet emerged with a clearly demonstrated benefit for treating the disorder. A case is made that tricyclic drugs deserve a closer look, based on their ability to affect several of the main neurotransmitters that are relevant to PTSD. Their promising efficacy, which was shown 30 years ago, had not been followed up, until a recent trial of desipramine found advantages over a SSRI in PTSD with comorbid alcohol dependence. Opportunities exist for studying newer and purportedly safer tricyclic formulations, as well as further the work with older, established compounds. A reappraisal of their risk:benefit ratio seems in order, when treating PTSD.
血清素（SSRI）和血清素-去甲肾上腺素（SNRI）再摄取抑制剂是创伤后应激障碍（PTSD）的一线推荐药物治疗方法；但尽管它们有好处，仍有许多残留病理存在，且尚未出现对治疗该疾病有明确益处的新药。基于三环类药物影响与PTSD相关的几种主要神经递质的能力，有理由对其进行更深入的研究。它们在30年前就显示出有前景的疗效，但一直没有后续研究，直到最近一项关于地昔帕明的试验发现，在伴有酒精依赖的PTSD患者中，地昔帕明比SSRI更具优势。研究更新的、据称更安全的三环类制剂以及对更老的、已确立的化合物进行进一步研究的机会是存在的。在治疗PTSD时，似乎有必要重新评估它们的风险效益比。
