a Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation , King's College London , London , UK.
b University of Nottingham, Palliative Medicine, Hayward House Specialist Palliative Care Unit , Nottingham University Hospitals NHS Trust , Nottingham , UK.
Expert Rev Respir Med. 2019 Feb;13(2):173-180. doi: 10.1080/17476348.2019.1563486. Epub 2018 Dec 30.
Chronic breathlessness is a common and distressing symptom of advanced disease with few effective treatments. Central nervous system mechanisms are important in respiratory sensation and control. Consequently, drugs which may modify processing and perception of afferent information in the brain may have a role. Antidepressants have been proposed; however, current evidence is limited. Of potentially suitable antidepressants, mirtazapine is an attractive option given its tolerability profile, low cost, and wide availability, along with additional potential benefits. Areas covered: The paper provides an overview of the physiology of breathlessness, with an emphasis on central mechanisms, particularly the role of fear circuits and the associated neurotransmitters. It provides a potential rationale for how mirtazapine may improve chronic breathlessness and quality of life in patients with advanced disease. The evidence was identified by a literature search performed in PubMed through to October 2018. Expert opinion: Currently, there is insufficient evidence to support the routine use of antidepressants for chronic breathlessness in advanced disease. Mirtazapine is a promising candidate to pursue, with definitive randomized controlled trials required to determine its efficacy and safety in this setting.
慢性呼吸困难是一种常见且令人痛苦的晚期疾病症状，目前治疗方法有限。中枢神经系统机制在呼吸感知和控制中起着重要作用。因此，可能改变大脑中传入信息处理和感知的药物可能具有作用。已经提出了使用抗抑郁药；然而，目前的证据有限。在潜在合适的抗抑郁药中，米氮平是一个有吸引力的选择，因为它具有良好的耐受性、低成本和广泛的可获得性，以及额外的潜在益处。涵盖领域：本文概述了呼吸困难的生理学，重点介绍了中枢机制，特别是恐惧回路及其相关神经递质的作用。它为米氮平如何改善晚期疾病患者的慢性呼吸困难和生活质量提供了潜在的理论依据。证据是通过在 PubMed 中进行文献检索至 2018 年 10 月获得的。专家意见：目前，没有足够的证据支持常规使用抗抑郁药治疗晚期疾病的慢性呼吸困难。米氮平是一个很有前途的候选药物，需要进行明确的随机对照试验来确定其在这种情况下的疗效和安全性。
