Glassman A H, Carino J S, Roose S P
Adv Biochem Psychopharmacol. 1984;39:391-8.
By and large the tricyclic antidepressants are safe drugs. The adverse events associated with them often have more to do with the individual patient and any preexisting medical conditions or co-administered medications than with the particular tricyclic drug used. Only rarely will it prove unwise to treat major affective disorders with a tricyclic. The vast majority of the time the benefits of drug treatment will outweigh the risks. In milder cases or in patients whose depression is a symptom rather than a syndrome, the situation is more complex. Because a drug response becomes less certain and a placebo response more likely, one must very carefully balance the risks involved against the likely benefits of specific antidepressant treatment. While there are more frequent indications for the use of an antidepressant drug in a geriatric population than in a younger group, the risk of tricyclic antidepressant treatment undoubtedly increases as patients grow older. But even in the elderly, if a patient is healthy the drug is probably safe. Only when a patient has preexisting conduction disease, far advanced cardiovascular disease, or is on multiple other drugs are the risks of tricyclic treatment high. Here in particular, a careful understanding of the underlying pharmacology of the tricyclic drugs and their adverse reactions can produce a more rational and safe basis for treatment.
总体而言，三环类抗抑郁药是安全的药物。与其相关的不良事件往往更多地与个体患者以及任何已有的医疗状况或同时服用的药物有关，而非与所使用的特定三环类药物有关。用三环类药物治疗重度情感障碍很少会被证明是不明智的。绝大多数情况下，药物治疗的益处将超过风险。在症状较轻的病例或抑郁症只是一种症状而非综合征的患者中，情况更为复杂。因为药物反应变得不那么确定，而安慰剂反应更有可能出现，所以必须非常仔细地权衡所涉及的风险与特定抗抑郁治疗可能带来的益处。虽然老年人群中使用抗抑郁药物的指征比年轻人群更频繁，但随着患者年龄的增长，三环类抗抑郁药治疗的风险无疑会增加。但即使是在老年人中，如果患者身体健康，这种药物可能是安全的。只有当患者已有传导疾病、严重的心血管疾病或正在服用多种其他药物时，三环类治疗的风险才会很高。特别是在这里，对三环类药物的潜在药理学及其不良反应有深入的了解，可以为治疗提供更合理、更安全的依据。
