Rickels K, Schweizer E
Department of Psychiatry, University of Pennsylvania, Philadelphia 19104-2649.
J Clin Psychiatry. 1993 Jan;54 Suppl:20-3.
Concomitant depressive symptoms occur in at least 50% of patients with a primary diagnosis of generalized anxiety disorder (GAD). The authors review the treatment implications of the presence of concomitant depressive symptoms. First considered is the extent to which traditional benzodiazepines, because of their suggested depressogenic liability, are indicated or contraindicated for such patients and the possible differential therapeutic advantage of triazolobenzodiazepines, which have shown preliminary antidepressant effect. Second, the role of tricyclic antidepressants in the treatment of GAD is reviewed. A large body of literature, mostly from the 1970s, has found benefit for the tricyclics in mixed anxiety-depression. Two studies published in the 1980s found that patients suffering from a primary anxiety diagnosis but with subsyndromic levels of depression benefited from treatment with tricyclic antidepressants. The authors also review the role of the azapirones, most notably buspirone, in the treatment of GAD complicated by depressive symptoms. Evidence for its efficacy in this population comes from both retrospective analysis of previous GAD treatment studies, as well as a recent prospective study of depression with concomitant GAD.
至少50%的原发性广泛性焦虑症（GAD）患者会出现伴发的抑郁症状。作者回顾了伴发抑郁症状的治疗意义。首先考虑的是，由于传统苯二氮䓬类药物具有潜在的致抑郁倾向，这类药物对此类患者是适用还是禁忌，以及三唑苯二氮䓬类药物可能具有的不同治疗优势，这类药物已显示出初步的抗抑郁效果。其次，回顾了三环类抗抑郁药在治疗广泛性焦虑症中的作用。大量文献（大多来自20世纪70年代）发现三环类药物对混合性焦虑抑郁有效。20世纪80年代发表的两项研究发现，原发性焦虑症但伴有亚综合征水平抑郁的患者从三环类抗抑郁药治疗中获益。作者还回顾了氮杂螺环癸烷二酮类药物，尤其是丁螺环酮，在治疗伴有抑郁症状的广泛性焦虑症中的作用。其在该人群中的疗效证据来自既往广泛性焦虑症治疗研究的回顾性分析，以及最近一项针对伴发广泛性焦虑症的抑郁症的前瞻性研究。
