Nunes E, Quitkin F, Brady R, Post-Koenig T
Columbia University College of Physicians and Surgeons, Department of Psychiatry, New York, NY, USA.
J Addict Dis. 1994;13(3):13-24. doi: 10.1300/j069v13n03_02.
We review the controlled trials of antidepressant treatment in methadone patients. Several studies show antidepressant effects, but none demonstrate clear improvement in drug abuse. This is contrary to "self-medication" but rather suggests depression is either independent or substance induced. Methodologic limitations are noted, especially reliance on cross-sectional mood assessment, which may select transient mood disturbances rather than true affective disorder. We review our previously published pilot study of imipramine in depressed methadone patients selected by lifetime history, and we report four year treatment course in the nine patients who responded favorably during that trial. Patients remained euthymic during imipramine treatment and relapsed to depression during attempts to taper it. This suggests imipramine had an enduring antidepressant effect. However, intermittent drug use remained a problem for several patients, suggesting depression and drug abuse are at least in part independent disorders. Placebo controlled replications, combinations of antidepressant medication with psychosocial interventions, and exploration of antidepressants as adjuncts in methadone detoxification, are suggested avenues for further research.
我们回顾了美沙酮患者抗抑郁治疗的对照试验。多项研究显示出抗抑郁效果，但无一表明药物滥用情况有明显改善。这与“自我用药”相悖，反而提示抑郁症要么是独立的，要么是物质诱发的。文中指出了方法学上的局限性，尤其是依赖横断面情绪评估，这可能会挑选出短暂的情绪障碍而非真正的情感障碍。我们回顾了我们之前发表的关于丙咪嗪治疗根据终生病史挑选出的抑郁美沙酮患者的初步研究，并报告了在该试验中反应良好的9名患者的四年治疗过程。患者在丙咪嗪治疗期间保持心境正常，而在尝试减药时复发为抑郁。这表明丙咪嗪具有持久的抗抑郁作用。然而，几名患者间歇性用药仍是个问题，提示抑郁症和药物滥用至少部分是独立的疾病。建议进行安慰剂对照重复试验、将抗抑郁药物与心理社会干预相结合，以及探索抗抑郁药物作为美沙酮脱毒辅助药物，这些都是进一步研究的途径。
