Beckmann H, Schmauss M
Arch Psychiatr Nervenkr (1970). 1983;233(1):59-70. doi: 10.1007/BF00540037.
It is assumed that established antidepressants exert their clinical efficacy by potentiation or decrease of central noradrenergic and serotonergic neurotransmission. However, recent experimental work suggests that antihistaminic and/or cholinolytic effects may also be involved. This double-blind controlled study compared amitriptyline (catecholamine potentiating, antihistaminic, cholinolytic) with promethazine (antihistaminic, cholinolytic) in 50 severely depressed inpatients over a 30-day treatment period. Analysis of the Hamilton depression rating scale revealed significant clinical superiority of amitriptyline over promethazine in such major depressive symptoms as depressed mood, suicidal ideation, psychic anxiety, and sleep disturbances. No significant difference was evident as far as autonomous side effects were concerned. Similar results were found by analysis of the AMP rating system. It is concluded that antihistaminic or cholinolytic effects per se do not explain the antidepressants' efficacy. However, potentiation of noradrenergic neurotransmission by cholinolytic activity might be the major antidepressive mechanism.
一般认为，已有的抗抑郁药通过增强或减弱中枢去甲肾上腺素能和5-羟色胺能神经传递来发挥其临床疗效。然而，最近的实验研究表明，抗组胺和/或抗胆碱作用可能也与之有关。这项双盲对照研究在50名重度抑郁住院患者中，对阿米替林（增强儿茶酚胺、抗组胺、抗胆碱）和异丙嗪（抗组胺、抗胆碱）进行了为期30天的治疗比较。对汉密尔顿抑郁评定量表的分析显示，在诸如情绪低落、自杀观念、精神焦虑和睡眠障碍等主要抑郁症状方面，阿米替林在临床上明显优于异丙嗪。就自主神经副作用而言，未发现明显差异。通过对AMP评定系统的分析也得到了类似结果。得出的结论是，抗组胺或抗胆碱作用本身并不能解释抗抑郁药的疗效。然而，抗胆碱活性增强去甲肾上腺素能神经传递可能是主要的抗抑郁机制。
