Mesure G, Fallet A, Chevalier J F
Service de Psychiatrie, Centre hospitalier de Versailles, hôpital Richaud, Versailles.
Encephale. 1995 Sep-Oct;21(5):609-14.
The authors report a case of acute mania induced by perindopril (Coversyl) in a 57 year old man with no prior history of mental illness. This Angiotensin-Converting Enzyme Inhibitor (ACEI) had been introduced eight days prior to the first signs of excitation, in order to treat recently diagnosed arterial hypertension. Without proof of reintroduction, and on the basis of clinical observations, the attribution appears plausible. Similar observations have been made for other molecules in this class of medication, such as captopril (Lopril). A review of literature regroups recent data concerning psychotropic effects of ACEIs. Several reports claim that captopril clearly acts as an antidepressant. Studies on the mood or the quality of life of treated hypertensive patients show ACEIs to have an euphoric-type positive effect compared to other anti-hypertensive treatments. Captopril and perindopril also act like potential antidepressants in experimental models of antidepression. Furthermore, pharmacologic data confirm that the most lipophilic ACEIs penetrate the central nervous system and argue in favor of the role of these molecules in activating central opioides. As these data provide evidence of mood swing in some patients, but also of an overall benefit in hypertensive populations, the clinical importance of the antidepressant effect of ACEIs needs further investigations.
作者报告了一例由培哚普利（雅施达）诱发急性躁狂的病例，患者为一名57岁男性，既往无精神疾病史。为治疗近期诊断出的动脉高血压，在出现兴奋的最初迹象前八天开始使用这种血管紧张素转换酶抑制剂（ACEI）。在没有再次用药证据的情况下，基于临床观察，这种归因似乎合理。对于此类药物中的其他分子，如卡托普利（开博通），也有类似观察结果。一篇文献综述汇总了有关ACEI精神药物作用的最新数据。一些报告称卡托普利明显具有抗抑郁作用。对接受治疗的高血压患者的情绪或生活质量研究表明，与其他抗高血压治疗相比，ACEI具有欣快型的积极作用。在抗抑郁实验模型中，卡托普利和培哚普利也表现出潜在的抗抑郁作用。此外，药理学数据证实，亲脂性最强的ACEI可穿透中枢神经系统，支持这些分子在激活中枢阿片类物质中的作用。由于这些数据既证明了某些患者会出现情绪波动，也表明了对高血压人群总体有益，ACEI抗抑郁作用的临床重要性需要进一步研究。
