Nair N P, Ahmed S K, Kin N M, West T E
T.E.G. West Douglas Hospital Research Centre, Verdun, Quebec, Canada.
Acta Psychiatr Scand Suppl. 1995;386:28-35. doi: 10.1111/j.1600-0447.1995.tb05921.x.
The treatment of depression in the elderly population needs a thorough and careful work-up and an aggressive therapeutic approach. Any treatment initiative in this population often becomes difficult because of accompanying physical illness, concomitant medication, possible degenerative changes in central nervous system and age-related altered metabolic status. Despite unevenness in research findings, pharmacological treatment remains the mainstay of management of depression among elderly people. Currently available antidepressants, although effective, are problematic because of the increased vulnerability of the elderly to side effects. Recent research efforts to improve the efficacy and safety of drug treatment of depression resulted in development of reversible and selective monoamine oxidase inhibitors of the isoenzyme A (RIMA), with antidepressant efficacy comparable to tricyclic antidepressants and newer generation antidepressants. RIMAs include moclobemide, brofaromine, toloxatone and cimoxatone. Moclobemide is the most investigated available RIMA for therapeutic use at present. Its absorption and disposition in elderly individuals do not differ significantly from those in young healthy volunteers and depressed patients. The results of present clinical studies show that, in elderly depressed patients, moclobemide is at least as effective as other antidepressants. Its particular advantage is, however, that it is as well tolerated in elderly people as in younger people. There are only few significant adverse events, and they are generally less frequent and less severe than those with TCAs. An additional attribute of moclobemide seems also to be its beneficial effect on cognitive functions.
老年人群抑郁症的治疗需要全面而细致的检查以及积极的治疗方法。由于存在伴随的躯体疾病、合并用药、中枢神经系统可能的退行性改变以及与年龄相关的代谢状态改变，在这一人群中开展任何治疗举措往往都很困难。尽管研究结果参差不齐，但药物治疗仍是老年抑郁症管理的主要手段。目前可用的抗抑郁药虽然有效，但由于老年人更容易出现副作用，所以存在问题。最近为提高抑郁症药物治疗的疗效和安全性所做的研究努力，促成了可逆性和选择性单胺氧化酶A同工酶抑制剂（RIMA）的研发，其抗抑郁疗效与三环类抗抑郁药及新一代抗抑郁药相当。RIMA包括吗氯贝胺、溴法罗明、托洛沙酮和西莫沙酮。吗氯贝胺是目前研究最多的可供治疗使用的RIMA。它在老年个体中的吸收和代谢与年轻健康志愿者及抑郁症患者相比并无显著差异。目前的临床研究结果表明，在老年抑郁症患者中，吗氯贝胺至少与其他抗抑郁药一样有效。然而，它的特别优势在于，老年人对其耐受性与年轻人相当。只有少数显著的不良事件，而且它们通常比三环类抗抑郁药引起的不良事件频率更低、程度更轻。吗氯贝胺的另一个特性似乎还在于它对认知功能有有益影响。
