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Bupropion 在帕金森病伴发抑郁或神经精神症状患者中的临床应用:范围综述。

Clinical uses of Bupropion in patients with Parkinson's disease and comorbid depressive or neuropsychiatric symptoms: a scoping review.

机构信息

Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, Luigi Sacco Hospital, University of Milan, Via G.B. Grassi, 74, 20157, Milan, Italy.

"Aldo Ravelli" Center for Neurotechnology and Brain Therapeutic, University of Milan, Milan, Italy.

出版信息

BMC Neurol. 2022 May 5;22(1):169. doi: 10.1186/s12883-022-02668-4.

Abstract

OBJECTIVE

Bupropion, an antidepressant inhibiting the reuptake of dopamine and noradrenaline, should be useful to treat depressive symptoms in patients with Parkinson's disease (PD). Limited and conflicting literature data questioned its effectiveness and safety in depressed PD patients and extended its use to other neuropsychiatric symptoms associated with this disorder.

DESIGN

The databases PubMed, Embase, Web of Sciences, Cochrane Library, and the grey literature were searched. Following a scoping review methodology, articles focusing on Bupropion uses in PD patients who manifested depressive or other neuropsychiatric alterations were reviewed.

RESULTS

Twenty-three articles were selected, including 7 original articles, 3 systematic reviews or meta-analyses, 11 case reports, 1 clinical guideline, and 1 expert opinion. Bupropion showed considerable effectiveness in reducing depressive symptoms, particularly in relation to apathy. Solitary findings showed a restorative effect on compulsive behaviour secondary to treatment with dopamine as well as on anxiety symptoms. The effect on motor symptoms remains controversial. The safety profile of this medication seems positive, but additional precautions should be used in subjects with psychotic symptoms.

CONCLUSION

The available literature lacks good evidence to support the use of Bupropion in PD patients presenting depressive symptoms. Further investigations are needed to extend and confirm reported findings and to produce accurate clinical guidelines.

摘要

目的

安非他酮是一种抑制多巴胺和去甲肾上腺素再摄取的抗抑郁药,对于治疗帕金森病(PD)患者的抑郁症状应该是有效的。但有限且相互矛盾的文献数据对其在抑郁 PD 患者中的疗效和安全性提出了质疑,并将其应用扩展到与该疾病相关的其他神经精神症状。

设计

检索了 PubMed、Embase、Web of Sciences、Cochrane 图书馆和灰色文献数据库。采用范围综述方法,对安非他酮在出现抑郁或其他神经精神改变的 PD 患者中的使用情况进行了综述。

结果

共选择了 23 篇文章,包括 7 篇原始文章、3 篇系统评价或荟萃分析、11 篇病例报告、1 项临床指南和 1 项专家意见。安非他酮在减轻抑郁症状方面显示出相当大的疗效,特别是在治疗冷漠方面。单独的研究结果表明,它对因多巴胺治疗引起的强迫行为以及焦虑症状具有恢复作用。它对运动症状的影响仍存在争议。该药物的安全性状况似乎良好,但对于有精神病症状的患者应采取额外的预防措施。

结论

现有文献缺乏支持安非他酮在出现抑郁症状的 PD 患者中使用的良好证据。需要进一步的研究来扩展和证实已报告的发现,并制定准确的临床指南。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/496e/9069850/66b6d3873aab/12883_2022_2668_Fig1_HTML.jpg

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