Gram L
Department of Clinical Pharmacology, Odense University, Denmark.
N Engl J Med. 1994 Nov 17;331(20):1354-61. doi: 10.1056/NEJM199411173312008.
Fluoxetine was developed as an antidepressant drug. It is more effective than placebo, but a dose-effect relation has not been established. Fluoxetine is almost as effective as tricyclic antidepressant drugs, but the available studies do not allow accurate comparisons. Fluoxetine may be less effective than tricyclic antidepressant drugs for the treatment of inpatients with severe melancholic depression, and it should not be the first choice of a drug for them. Fluoxetine may be most appropriate for patients with moderate depression who can be treated as outpatients. If there is little improvement after treatment for four to six weeks, an alternative treatment should be offered. Fluoxetine does not have the anticholinergic, hypotensive, and sedative effects of tricyclic antidepressant drugs and has no particular cardiovascular effects; overdoses do not cause serious toxic effects. Nausea, anorexia, insomnia, and nervousness--the most common side effects--may be controlled with a careful adjustment to the dose. Clinically important drug interactions may occur with monoamine oxidase inhibitors, tricyclic antidepressant drugs, and other drugs. The published data on the antidepressant effect of fluoxetine do not fully explain its popularity. One may speculate that fluoxetine has psychobiologic effects not strictly related to the biology of depression and that it acts primarily as a mood- or affect-modulating agent.
氟西汀是作为一种抗抑郁药物研发出来的。它比安慰剂更有效，但尚未确立剂量效应关系。氟西汀几乎与三环类抗抑郁药物一样有效，但现有研究无法进行准确比较。对于重度抑郁性抑郁症住院患者，氟西汀的疗效可能不如三环类抗抑郁药物，因此不应作为他们的首选药物。氟西汀可能最适合可作为门诊患者治疗的中度抑郁症患者。如果治疗四至六周后改善甚微，应提供替代治疗。氟西汀没有三环类抗抑郁药物的抗胆碱能、降压和镇静作用，也没有特殊的心血管作用；过量服用不会导致严重的毒性作用。恶心、厌食、失眠和紧张——最常见的副作用——可通过仔细调整剂量来控制。与单胺氧化酶抑制剂、三环类抗抑郁药物及其他药物之间可能会发生具有临床意义的药物相互作用。关于氟西汀抗抑郁作用的已发表数据并不能完全解释其为何如此受欢迎。有人可能推测，氟西汀具有与抑郁症生物学并不严格相关的心理生物学效应，并且它主要作为一种情绪或情感调节药物起作用。
