Heninger G R, Charney D S, Price L H
Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven.
Acta Psychiatr Scand Suppl. 1988;341:138-50. doi: 10.1111/j.1600-0447.1988.tb08559.x.
Recent studies which have utilized the administration of neurotransmitter agonists and antagonists to study presynaptic and postsynaptic receptor system function in panic disorder and major depression are reviewed. In panic disorder, patients have been found to be overly sensitive to the alpha-2 adrenergic agonist clonidine, and the alpha-2-adrenergic antagonist yohimbine, but they have relatively normal responses to tryptophan, the precursor of serotonin, and MCPP, a directly acting serotonin agonist. In depression, patients appear to have relatively normal responses to clonidine and yohimbine except for some supersensitivity to yohimbine effects on blood pressure and subjective symptoms. In contrast to the panic disorder patients, depressed patients demonstrate a neuroendocrine subsensitivity to tryptophan. Taken together, these studies suggest a relative abnormality in the alpha-2-adrenergic regulation of the noradrenergic system in panic disorder and a subsensitivity of the serotonergic system in depression. The pharmacologic treatment response in panic disorder and depression is similar in that both conditions respond to tricyclic antidepressants and monoamine oxidase inhibitors, but different in that panic disorder does not respond to atypical antidepressants such as trazodone and bupropion, but does respond to benzodiazepines, in contrast to depression. The possible mechanisms involved in producing these findings and the methods to more fully study possible receptor system abnormalities in these illnesses are discussed.
本文综述了近期利用神经递质激动剂和拮抗剂来研究惊恐障碍和重度抑郁症中突触前和突触后受体系统功能的研究。在惊恐障碍中，患者被发现对α-2肾上腺素能激动剂可乐定和α-2肾上腺素能拮抗剂育亨宾过度敏感，但他们对血清素的前体色氨酸和直接作用的血清素激动剂MCPP的反应相对正常。在抑郁症中，患者对可乐定和育亨宾的反应似乎相对正常，只是对育亨宾对血压和主观症状的影响存在一些超敏反应。与惊恐障碍患者不同，抑郁症患者对色氨酸表现出神经内分泌敏感性降低。综合来看，这些研究表明惊恐障碍中去甲肾上腺素能系统的α-2肾上腺素能调节存在相对异常，而抑郁症中血清素能系统存在敏感性降低。惊恐障碍和抑郁症的药物治疗反应有相似之处，即两种病症都对三环类抗抑郁药和单胺氧化酶抑制剂有反应，但也有不同之处，与抑郁症相反，惊恐障碍对曲唑酮和安非他酮等非典型抗抑郁药无反应，但对苯二氮䓬类药物有反应。本文还讨论了产生这些发现的可能机制以及更全面研究这些疾病中可能的受体系统异常的方法。
