White K, Simpson G
J Clin Psychiatry. 1984 Jul;45(7 Pt 2):67-9.
Combined MAOI-tricyclic treatment remains a plausible approach to depressions refractory to single drugs. Adherence to published guidelines should minimize special risks of the combined treatment. However, such risks do exist, and should be borne in mind. Most severe reactions - characterized by hyperthermia, delirium, convulsions, and sometimes fatal outcome - have occurred after a tricyclic was added to established MAOI treatment. Combined treatment may be associated with a lower risk of hypertensive crisis than treatment with MAOI alone. There are no data from double-blind, control-group studies to demonstrate an advantage for the MAOI-tricyclic combination in refractory depression. However, almost no such data exist to establish the advantage of any other treatment in this clinical situation. Clinical experience provides the primary basis for continued consideration of this approach when usual treatments have failed.
单胺氧化酶抑制剂（MAOI）与三环类药物联合治疗仍然是一种治疗对单一药物难治性抑郁症的可行方法。遵循已发表的指南应能将联合治疗的特殊风险降至最低。然而，此类风险确实存在，应予以牢记。最严重的反应——以高热、谵妄、惊厥为特征，有时甚至会导致致命后果——发生在已确立的MAOI治疗基础上加用三环类药物之后。联合治疗可能比单独使用MAOI治疗引发高血压危象的风险更低。尚无双盲对照研究数据表明MAOI与三环类药物联合治疗在难治性抑郁症方面具有优势。然而，几乎也没有此类数据能证实任何其他治疗方法在这种临床情况下的优势。当常规治疗失败时，临床经验是继续考虑这种治疗方法的主要依据。
