Gastpar M
Klinik für allgemeine Psychiatrie, Rheinische Landes- und Hochschulklinik, Essen, Federal Republic of Germany.
Drugs. 1989;38 Suppl 1:43-8; discussion 49-50. doi: 10.2165/00003495-198900381-00010.
Trimipramine differs from other antidepressant drugs in a number of ways. Although trimipramine shares equivalent efficacy with doxepin, imipramine, maprotiline and amitriptyline, as evidenced by double-blind studies, it possesses a different side-effect profile. Trimipramine is considered to be less cardiotoxic, and data presented in this paper support its minimal effect on orthostatic hypotension, as compared with clomipramine. In addition, trimipramine has less epileptogenic potential than other antidepressants such as imipramine, amitriptyline and maprotiline. Besides this different side-effect profile, trimipramine exerts differing effects on neurotransmitter functions and their reuptake. For example, trimipramine does not inhibit reuptake of noradrenaline and serotonin, and does not down-regulate beta 1-adrenoceptors. Furthermore, in common with lithium, trimipramine produces enhancement of antidepressant action in treatment-resistant depressed patients. There is evidence that trimipramine enhances the sensitivity of cortical neurons to noradrenaline after prolonged administration and may also increase the activity of serotonin neurons.
三甲丙咪嗪在许多方面与其他抗抑郁药物不同。虽然双盲研究表明三甲丙咪嗪与多塞平、丙咪嗪、马普替林和阿米替林具有同等疗效，但它具有不同的副作用谱。三甲丙咪嗪被认为心脏毒性较小，本文提供的数据表明，与氯米帕明相比，它对体位性低血压的影响最小。此外，三甲丙咪嗪的致癫痫潜力低于其他抗抑郁药，如丙咪嗪、阿米替林和马普替林。除了这种不同的副作用谱外，三甲丙咪嗪对神经递质功能及其再摄取也有不同的影响。例如，三甲丙咪嗪不抑制去甲肾上腺素和5-羟色胺的再摄取，也不下调β1-肾上腺素能受体。此外，与锂一样，三甲丙咪嗪在治疗抵抗性抑郁症患者中可增强抗抑郁作用。有证据表明，长期给药后，三甲丙咪嗪可增强皮质神经元对去甲肾上腺素的敏感性，还可能增加5-羟色胺能神经元的活性。
