Schildkraut J J, Kety S S
Science. 1967 Apr 7;156(3771):21-37. doi: 10.1126/science.156.3771.21.
The studies discussed here have shown a fairly consistent relationship between the effects of drugs on biogenic amines, particularly norepinephrine, and affective or behavioral states. Those drugs which cause depletion and inactivation of norepinephrine centrally produce sedation or depression, while drugs which increase or potentiate brain norepinephrine are associated with behavioral stimulation or excitement and generally have an antidepressant effect in man (Table 1). From these findings, a number of investigators have formulated the concept, designated the catecholamine hypothesis of affective disorders (6), that some, if not all, depressions may be associated with a relative deficiency of norepinephrine at functionally important adrenergic receptor sites in the brain, whereas elations may be associated with an excess of such amines. It is not possible either to confirm or to reject this hypothesis on the basis of currently available clinical data. Although there does appear to be a fairly consistent relationship between the effects of pharmacological agents on norepinephrine metabolism and on affective state, a rigorous extrapolation from pharmacological studies to pathophysiology cannot be made. Confirmation of this hypothesis must ultimately depend upon direct demonstration of the biochemical abnormality in the naturally occurring illness. It should be emphasized, however, that the demonstration of such a biochemical abnormality would not necessarily imply a genetic or constitutional, rather than an environmental or psychological, etiology of depression. Whereas specific genetic factors may be of importance in the etiology of some, and possibly all, depressions, it is equally conceivable that early experiences of the infant or child may cause enduring biochemical changes and that these may predispose some individuals to depressions in adulthood. It is not likely that changes in the metabolism of the biogenic amines alone will account for the complex phenomena of normal or pathological affect. Whereas the effects of these amines at particular sites in the brain may be of crucial importance in the regulation of affect, any comprehensive formulation of the physiology of affective state will have to include many other concomitant biochemical, physiological, and psychological factors. Although in this review of the relationship of biogenic amines to affective state relatively little has been said concerning the intricate set of environmental and psychological determinants of emotion, the importance of these factors must be stressed. The normally occurring alterations in affective state induced by environmental events is well known to all, from personal experience. The interactions between such environmental determinants of affect, various physiological factors, and the complexity of psychological determinants, including cognitive factors derived from the individual's remote and immediate past experiences, have received only limited study under adequately controlled conditions. It may be anticipated, however, that this will prove to be a particularly fruitful area for future research, for only within such a multifactorial framework may one expect to understand fully the relationship of the biogenic amines to emotional state.
此处讨论的研究表明,药物对生物胺,尤其是去甲肾上腺素的作用与情感或行为状态之间存在相当一致的关系。那些导致去甲肾上腺素在中枢耗竭和失活的药物会产生镇静或抑郁作用,而那些增加或增强脑内去甲肾上腺素的药物则与行为兴奋或激动有关,并且通常对人有抗抑郁作用(表1)。基于这些发现,许多研究人员提出了一个概念,即情感障碍的儿茶酚胺假说(6),认为部分(如果不是全部)抑郁症可能与脑内功能重要的肾上腺素能受体部位去甲肾上腺素相对缺乏有关,而躁狂可能与这类胺类物质过量有关。根据目前可用的临床数据,既无法证实也无法反驳这一假说。虽然药理剂对去甲肾上腺素代谢的作用与情感状态之间似乎确实存在相当一致的关系,但不能从药理研究严格推断到病理生理学。这一假说的证实最终必须依赖于在自然发生的疾病中直接证明生化异常。然而,应该强调的是,这种生化异常的证明不一定意味着抑郁症的病因是遗传或体质性的,而不是环境或心理性的。虽然特定的遗传因素可能在部分(甚至可能是所有)抑郁症的病因中起重要作用,但同样可以想象,婴儿或儿童早期的经历可能会导致持久的生化变化,这些变化可能使一些个体在成年后易患抑郁症。单是生物胺代谢的变化不太可能解释正常或病理性情感的复杂现象。虽然这些胺类物质在脑内特定部位的作用可能对情感调节至关重要,但情感状态生理学的任何全面阐述都必须包括许多其他伴随的生化、生理和心理因素。尽管在这篇关于生物胺与情感状态关系的综述中,相对较少提及情感的一系列复杂环境和心理决定因素,但必须强调这些因素的重要性。从个人经历可知,环境事件引起的情感状态的正常变化是众所周知的。在充分控制的条件下,对情感的这些环境决定因素、各种生理因素以及心理决定因素的复杂性(包括源自个体远期和近期过去经历的认知因素)之间的相互作用的研究还很有限。然而,可以预期,这将被证明是未来研究特别富有成果的领域,因为只有在这样一个多因素框架内,人们才有望充分理解生物胺与情感状态的关系。