Non-Invasive neuroModulation Center of Strasbourg (CEMNIS), University Hospital of Strasbourg, 67000 Strasbourg, France; CNRS UMR 7357 iCube, neurophysiology, FMTS, University of Strasbourg, 67000 Strasbourg, France.
Non-Invasive neuroModulation Center of Strasbourg (CEMNIS), University Hospital of Strasbourg, 67000 Strasbourg, France; CNRS UMR 7357 iCube, neurophysiology, FMTS, University of Strasbourg, 67000 Strasbourg, France.
Encephale. 2024 Apr;50(2):137-142. doi: 10.1016/j.encep.2023.01.011. Epub 2023 Mar 31.
Dopamine (DA) is likely to be involved in some depressive dimensions, such as anhedonia and amotivation, which account for a part of treatment-resistant forms. Monoamine oxidase inhibitors (MAOI) and direct D2 and D3 receptors agonists (D2/3r-dAG) are known to help, but we lack safety data about their combined usage. We report on safety and tolerance of the MAOI+D2r-dAG combination in a clinical series.
All patients referred to our recourse center for depression between 2013 and 2021 were screened to select those who did receive the combo. Data were extracted from clinical files.
Sixteen patients of 60±17 years of age (8 women, 7 with age>65years, all suffered from treatment resistant depression, 7 with bipolar disorder) received the combo. There were no life-threatening adverse effects (AE). However, AE were reported by 14 patients (88%) most of which were mild and consisted of insomnia, nausea, nervousness, confusion, impulse control disorder and/or "sleep attacks". One patient presented a serious AE requiring a short hospitalization for confusion. Intolerance led to failure to introduce treatment in two patients (13%). The retrospective non-interventional design, the variety of molecules, and the modest sample size limited the scope of these results.
There was no life-threatening safety issue in combining MAOI and D2/3r-dAG, especially regarding cardiovascular side effects. The systematic screening of AE might account for their frequency, but these precluded the treatment in only two patients. Comparative studies are needed to assess the efficacy of this new combination.
多巴胺（DA）可能与一些抑郁维度有关，如快感缺失和动机缺乏，这些维度构成了部分治疗抵抗形式的原因。单胺氧化酶抑制剂（MAOI）和直接 D2 和 D3 受体激动剂（D2/3r-dAG）已被证明有助于治疗，但我们缺乏关于它们联合使用的安全性数据。我们报告了 MAOI+D2r-dAG 联合使用在一系列临床病例中的安全性和耐受性。
我们从 2013 年至 2021 年期间筛选了所有因抑郁症到我们的资源中心就诊的患者，以选择那些接受了该联合治疗的患者。数据从临床档案中提取。
16 名年龄在 60±17 岁（8 名女性，7 名年龄>65 岁，均患有治疗抵抗性抑郁症，7 名患有双相情感障碍）的患者接受了该联合治疗。没有发生危及生命的不良事件（AE）。然而，14 名患者（88%）报告了 AE，大多数为轻度，包括失眠、恶心、紧张、意识混乱、冲动控制障碍和/或“睡眠发作”。一名患者因意识混乱需要短暂住院治疗而出现严重 AE。由于不耐受，有两名患者（13%）未能接受治疗。回顾性非干预设计、分子的多样性以及适度的样本量限制了这些结果的范围。
在 MAOI 和 D2/3r-dAG 联合使用中没有危及生命的安全性问题，特别是在心血管副作用方面。AE 的系统筛查可能解释了它们的高频率，但这仅导致两名患者无法接受治疗。需要进行比较研究来评估这种新联合治疗的疗效。
