Murphy D L, Siever L J, Insel T R
Prog Neuropsychopharmacol Biol Psychiatry. 1985;9(1):3-13. doi: 10.1016/0278-5846(85)90174-5.
Although therapeutic responsiveness to tricyclic antidepressants has been primarily associated with the affective disorders, clinical investigations in the last decade have suggested that non-affective disorders such as panic disorder, obsessive-compulsive disorder, anxiety disorder, bulimia, enuresis, migraine, and the chronic pain syndrome may also respond to tricyclics and other antidepressants. This therapeutic responsiveness may sometimes be related to improvement in secondary depressive symptoms, but may also clearly occur in the absence of secondary depression; in particular, improvement in the core symptoms of at least some of these disorders may occur without a change in mood. Furthermore, many patients with these disorders display psychobiologic abnormalities that show many similarities, but also some differences, compared to those observed in patients with affective disorders, despite the frequent absence of affective symptoms. While an improvement in subclinical or "masked" depression remains one hypothesis linking tricyclic responsiveness and shared biological abnormalities in this diverse group of diagnostic entities, an alternative hypothesis (the "ven disorder" hypothesis) is presented, suggesting the possibility that tricyclic and other antidepressant-responding patients have a core disorder with common psychobiologic abnormalities but multiple clinical and diagnostic presentations. An alternative hypothesis (the "shotgun" hypothesis) suggests that the multiple actions of tricyclics (e.g. on adrenergic receptors vs. muscarinic receptors vs. serotonin system changes) may each be differentially important in the therapeutic outcome in patients with specific or predominant problems in one or another of these areas. An examination of both the similarities and differences among the non-affective, tricyclic-responsive disorders and the affective disorders may provide clues about the important psychobiologic elements in these disorders, and to the mode of action of tricyclic antidepressants and related drugs across the psychiatric disorder spectrum.
虽然三环类抗抑郁药的治疗反应主要与情感障碍相关，但过去十年的临床研究表明，惊恐障碍、强迫症、焦虑症、贪食症、遗尿症、偏头痛和慢性疼痛综合征等非情感障碍也可能对三环类药物和其他抗抑郁药有反应。这种治疗反应有时可能与继发性抑郁症状的改善有关，但也可能在没有继发性抑郁的情况下明显出现；特别是，这些障碍中至少一些的核心症状可能在情绪没有变化的情况下得到改善。此外，许多患有这些障碍的患者表现出心理生物学异常，与情感障碍患者相比，这些异常有许多相似之处，但也有一些不同之处，尽管他们经常没有情感症状。虽然亚临床或“隐匿性”抑郁的改善仍然是将三环类药物反应性与这一多样的诊断实体组中共同的生物学异常联系起来的一种假设，但本文提出了另一种假设（“静脉疾病”假设），表明三环类药物和其他抗抑郁药反应性患者可能有一种核心疾病，具有共同的心理生物学异常，但有多种临床和诊断表现。另一种假设（“散弹枪”假设）表明，三环类药物的多种作用（例如对肾上腺素能受体、毒蕈碱受体、血清素系统变化的作用）在这些领域中一个或另一个存在特定或主要问题的患者的治疗结果中可能各自具有不同的重要性。对非情感性、三环类药物反应性障碍和情感障碍之间的异同进行研究，可能会为这些障碍中重要的心理生物学因素以及三环类抗抑郁药和相关药物在整个精神障碍谱系中的作用方式提供线索。
