Henry J A, Martin A J
National Poisons Unit, Guys Hospital London.
Med Toxicol Adverse Drug Exp. 1987 Nov-Dec;2(6):445-62. doi: 10.1007/BF03259878.
Antidepressant drugs in common use are reviewed in terms of their risks and benefits. A simple classification divides these into tricyclic antidepressants, monoamine oxidase inhibitors and second generation antidepressants. Risks may arise from the correct use of an antidepressant, from its incorrect or inappropriate use, or due to its failure to reverse the depression. The greatest risk is to leave the depression untreated. Risks due to adverse drug effects are generally predictable but in some cases are unexpected and have led to the withdrawal of the drug from the market. Assessing the benefits of antidepressant drugs is more difficult. Rating scales can be used in this context and the fact that the majority of antidepressant drugs have a similar degree of efficacy serves to emphasise the importance of making a risk-benefit assessment of each drug. This has been presented for the more widely used drugs. Safety in overdose is a particularly important benefit. The ideal antidepressant should specifically reverse depressive illness without toxic effects. Although no drug at present measures up to this it is clear that antidepressants should be prescribed, as their benefits outweigh their risks.
本文对常用抗抑郁药物的风险和益处进行了综述。简单分类可将其分为三环类抗抑郁药、单胺氧化酶抑制剂和第二代抗抑郁药。风险可能源于抗抑郁药的正确使用、不正确或不恰当使用，或由于未能缓解抑郁症状。最大的风险是任由抑郁症状得不到治疗。药物不良反应导致的风险通常是可预测的，但在某些情况下是意外发生的，这导致了一些药物退出市场。评估抗抑郁药物的益处则更为困难。在此背景下可使用评分量表，而且大多数抗抑郁药物具有相似程度的疗效这一事实，凸显了对每种药物进行风险效益评估的重要性。本文针对更广泛使用的药物进行了阐述。过量服用时的安全性是一项特别重要的益处。理想的抗抑郁药应能特异性地缓解抑郁疾病且无毒性作用。尽管目前尚无药物能达到这一标准，但很明显仍应开具抗抑郁药，因为其益处大于风险。
