Beckmann H, Holzmüller B, Fleckenstein P
Acta Psychiatr Scand. 1984 Oct;70(4):342-53. doi: 10.1111/j.1600-0447.1984.tb01219.x.
This prospective study investigates the possibility of a central noradrenergic-cholinergic imbalance in subgroups of depressed inpatients using the dexamethasone suppression test (DST) as one peripheral indicator. The DST was performed in 43 depressed inpatients. Subsequently, a group (n = 20) of DST suppressors (DST-) and a group (n = 23) of DST nonsuppressors (DST+) were treated under double blind conditions with either nomifensine (NOM) a noradrenaline potentiating drug, or amitriptyline (AMI) a noradrenaline potentiating and strong anticholinergic compound. DST+ depressives responded favorably to AMI, but not to NOM. Conversely, DST- depressives responded favorably to NOM but less well to AMI. Together with other biochemical findings this data suggests: 1) a hypofunction of the noradrenergic system in DST- patients who may, from a clinical point of view, usually show minor or 'neurotic' depressions; 2) a hypofunction of the noradrenergic and a hyperfunction of the cholinergic system in DST+ patients who may present a more severe or 'endogenous' depression. These data suggest a biochemical heterogeneity of depression and offer an aid for a more specific antidepressive drug therapy.
这项前瞻性研究使用地塞米松抑制试验（DST）作为一项外周指标，调查了抑郁症住院患者亚组中存在中枢去甲肾上腺素能 - 胆碱能失衡的可能性。对43名抑郁症住院患者进行了DST检测。随后，一组（n = 20）DST抑制者（DST-）和一组（n = 23）DST非抑制者（DST+）在双盲条件下分别接受去甲肾上腺素增强药物诺米芬辛（NOM）或去甲肾上腺素增强且具有强抗胆碱能作用的化合物阿米替林（AMI）治疗。DST+抑郁症患者对AMI反应良好，但对NOM无反应。相反，DST-抑郁症患者对NOM反应良好，但对AMI反应较差。结合其他生化研究结果，这些数据表明：1）DST-患者的去甲肾上腺素能系统功能减退，从临床角度来看，这些患者通常表现为轻度或“神经症性”抑郁；2）DST+患者的去甲肾上腺素能系统功能减退而胆碱能系统功能亢进，这些患者可能表现为更严重的或“内源性”抑郁。这些数据表明抑郁症存在生化异质性，并为更具针对性的抗抑郁药物治疗提供了帮助。
