Sabelli H C, Fawcett J, Javaid J I, Bagri S
Am J Psychiatry. 1983 Feb;140(2):212-4. doi: 10.1176/ajp.140.2.212.
Monitoring tricyclic antidepressant concentrations in the plasma of 43 patients with major depressive disorders indicated that some responded to imipramine or desipramine but not to amitriptyline or nortriptyline, or vice versa, even though plasma levels were within therapeutic ranges. Mood elevation by methylphenidate predicted marked improvement from treatment with imipramine or desipramine but not with amitriptyline or nortriptyline. When methylphenidate failed to improve mood, patients responded to amitriptyline or nortriptyline but not to desipramine. These results suggest differential drug responses with different tricyclic antidepressants, the clinical utility of the methylphenidate test, and the heterogeneity of depressions. The authors question the mechanism of action of nortriptyline via blockade of norepinephrine reuptake.
对43名重度抑郁症患者血浆中的三环类抗抑郁药浓度进行监测发现，尽管血浆水平在治疗范围内，但一些患者对丙咪嗪或地昔帕明有反应，对阿米替林或去甲替林无反应，反之亦然。哌甲酯引起的情绪改善预示着使用丙咪嗪或地昔帕明治疗会有显著改善，但使用阿米替林或去甲替林则不然。当哌甲酯未能改善情绪时，患者对阿米替林或去甲替林有反应，对去甲丙咪嗪无反应。这些结果表明不同三环类抗抑郁药存在不同的药物反应、哌甲酯试验的临床实用性以及抑郁症的异质性。作者对去甲替林通过阻断去甲肾上腺素再摄取的作用机制提出质疑。
