Carasso R L, Yehuda S, Streifler M
Int J Neurosci. 1979;9(3):191-4. doi: 10.3109/00207457909147672.
Clomipramine is the most potent 5-HT reuptake blockade agent among the antidepressants. A comparison between the effect of clomipramine and a less powerful 5-HT reuptake blockade agent (amitriptyline) could test the hypothesis that brain 5-HT is a mediator of pain sensation. Groups of patients of either sex, with pain indication of trigeminal neuralgia, tension headache or postherpatic neuralgia, received doses of clomipramine or amitriptyline in a single blind clinical experiment. The results after three months of treatment showed that clomipramine: (1) was better than amitriptyline in treating trigeminal neuralgia; (2) tended to be better in the treatment of tension headache; and (3) amitriptyline is better in treating postherpatic neuralgia. Clomipramine was better tolerated. The results support the hypothesis that in certain pain situations, clomipramine exerts a beneficial effect, not only because of its effect on the depression and anxiety level of the patient, but also via its effects on the 5-HT brain system.
氯米帕明是抗抑郁药中最有效的5-羟色胺再摄取阻断剂。比较氯米帕明和效力稍弱的5-羟色胺再摄取阻断剂（阿米替林）的效果，可以检验大脑5-羟色胺是痛觉介质这一假设。在一项单盲临床试验中，对患有三叉神经痛、紧张性头痛或带状疱疹后神经痛等疼痛症状的男女患者分组给予氯米帕明或阿米替林。治疗三个月后的结果显示，氯米帕明：（1）在治疗三叉神经痛方面优于阿米替林；（2）在治疗紧张性头痛方面往往效果更好；（3）阿米替林在治疗带状疱疹后神经痛方面效果更好。氯米帕明的耐受性更好。这些结果支持了这样一种假设，即在某些疼痛情况下，氯米帕明发挥有益作用，不仅是因为其对患者抑郁和焦虑水平的影响，还因其对大脑5-羟色胺系统的作用。
