Javelot H
Référent recherche, établissement public de santé Alsace Nord (EPSAN), 67170 Brumath, France; Réseau PIC - psychiatrie information communication, 59487 Armentières, France; Pharmacopsy Alsace, clinique de psychiatrie, CHU de Strasbourg, 67000 Strasbourg, France.
Ann Pharm Fr. 2016 Mar;74(2):93-118. doi: 10.1016/j.pharma.2015.09.001. Epub 2015 Oct 16.
Pharmacological treatment of acute anxiety still relies on benzodiazepines, while chronic anxiety disorders and depression are treated with different antidepressants, according to specific indications. The monoaminergic axis is represented by two families which are being developed: (i) serotonin-norepinephrine-dopamine reuptake inhibitors (SNDRI), also called triple reuptake inhibitors (TRI), for the treatment of depression (amitifadine), (ii) multimodal antidepressants for depression and anxiety disorders (generalized anxiety disorder mainly) (tedatioxetine, vortioxetine and vilazodone). Third-generation antipsychotics (aripiprazole, lurasidone, brexpiprazole, cariprazine) appear relevant in the treatment of resistant depression and some anxiety disorders. Among the modulators of the glutamatergic axis, promising compounds include: (i) ionotropic regulators of NMDA receptors: esketamine, AVP-923 and AVP-786, CERC-301, rapastinel (Glyx-13), NRX-1074 developed for depression, rapastinel and bitopertine developed for obsessive compulsive disorder, (ii) metabotropic glutamate receptors modulators: decoglurant and basimglurant developed for depression and mavoglurant developed for obsessive compulsive disorder.
急性焦虑的药物治疗仍依赖苯二氮䓬类药物，而慢性焦虑症和抑郁症则根据具体适应症使用不同的抗抑郁药进行治疗。单胺能轴由正在研发的两个药物类别代表：（i）5-羟色胺-去甲肾上腺素-多巴胺再摄取抑制剂（SNDRI），也称为三重再摄取抑制剂（TRI），用于治疗抑郁症（阿米法丁）；（ii）用于治疗抑郁症和焦虑症（主要是广泛性焦虑症）的多模式抗抑郁药（替达西汀、伏硫西汀和维拉唑酮）。第三代抗精神病药物（阿立哌唑、鲁拉西酮、布雷哌唑、卡立哌嗪）在治疗难治性抑郁症和某些焦虑症方面似乎具有相关性。在谷氨酸能轴调节剂中，有前景的化合物包括：（i）NMDA受体的离子型调节剂：艾司氯胺酮、AVP-923和AVP-786、CERC-301、瑞帕斯汀（Glyx-13）、为治疗抑郁症而研发的NRX-1074、为治疗强迫症而研发的瑞帕斯汀和安非他酮；（ii）代谢型谷氨酸受体调节剂：为治疗抑郁症而研发的地谷鲁特和巴辛鲁特，以及为治疗强迫症而研发的马谷鲁特。
