Sandyk R, Bamford C R
Department of Neurology, University of Arizona, Tucson 85724.
Int J Neurosci. 1988 Mar;39(1-2):27-9. doi: 10.3109/00207458808985689.
Gilles de la Tourette's syndrome (GTS) is a chronic neuropsychiatric disorder characterized by multiple involuntary motor and phonic tics associated with behavioural disturbances including obsessive-compulsive and aggressive behavior, depression and, rarely, psychosis. The relationship of GTS, presumed to be predominantly a dopaminergic disorder, and depression, presumed to be a noradrenergic-serotoninergic deficiency state, is currently poorly understood. The reports published to date on the effects of tricyclic antidepressants in GTS have been contradictory; while Messiha et al. (1976) used imipramine successfully in one GTS patient, Abuzzahab and Anderson (1973) and Fras (1978) on the other hand, found imipramine to exacerbate GTS symptoms and cautioned its usage in this syndrome. A more recent report suggested that imipramine is useful in GTS patients who exhibit symptoms of attention deficit disorder (Dillon et al., 1985). We report a patient with GTS whose depression and behaviour improved considerably when low-dose imipramine (Tofranil) was added to the regimen of anti-GTS medication. This report suggest that tricyclic antidepressants may be useful adjuncts in the management of GTS, and hints at norepinephrinergic and serotoninergic deficiencies as being components of the pathogenesis of the syndrome.
Gilles de la Tourette综合征（GTS）是一种慢性神经精神障碍，其特征为多种不自主运动和发声抽动，并伴有行为障碍，包括强迫行为和攻击行为、抑郁，以及罕见的精神病症状。GTS被认为主要是一种多巴胺能障碍，而抑郁症被认为是一种去甲肾上腺素能-5-羟色胺能缺乏状态，目前人们对它们之间的关系了解甚少。迄今为止，关于三环类抗抑郁药对GTS影响的报道相互矛盾；一方面，梅西哈等人（1976年）成功地将丙咪嗪用于一名GTS患者，而另一方面，阿卜扎哈卜和安德森（1973年）以及弗拉斯（1978年）发现丙咪嗪会加重GTS症状，并警告不要在此综合征中使用该药。最近一份报告表明，丙咪嗪对表现出注意力缺陷障碍症状的GTS患者有用（狄龙等人，1985年）。我们报告了一名GTS患者，当在抗GTS药物治疗方案中添加低剂量丙咪嗪（托弗尼尔）时，其抑郁和行为有了显著改善。本报告表明，三环类抗抑郁药可能是GTS治疗中的有用辅助药物，并提示去甲肾上腺素能和5-羟色胺能缺乏是该综合征发病机制的组成部分。
