Gillin J C, Lauriello J, Kelsoe J R, Rapaport M, Golshan S, Kenny W M, Sutton L
Department of Psychiatry, University of California, San Diego, USA.
Psychiatry Res. 1995 Sep 29;58(2):99-105. doi: 10.1016/0165-1781(95)02700-7.
Depression may result from an increased ratio of cholinergic to aminergic central neurotransmission. The effect of centrally active anticholinergic agents on depressive ratings in depressed patients, however, has not been well studied. In a previous open label 4-week clinical trial, Kasper et al. (1981) reported that biperiden (Akineton) had antidepressant effects in depressed patients. We compared the effects of placebo and biperiden in a randomized, double-blind, parallel-design 6-week study. All patients received placebo for the first week and then received either biperiden (< or = 12 mg/day) or a peripherally acting anticholinergic agent, glycopyrrolate (Robinul, 1 mg/day) for 4 weeks. All patients received placebo during week 6. Both groups significantly improved, but biperiden did not demonstrate any significant benefit compared with glycopyrrolate. In a subgroup of patients receiving biperiden, the percentage of rapid eye movement sleep was significantly decreased only in the first week of biperiden compared with the initial placebo week, suggesting that tolerance to the central effects of biperiden developed. Further studies would be needed to determine whether anticholinergic agents possess antidepressant properties.
抑郁症可能源于胆碱能与胺能中枢神经传递比例的增加。然而，中枢活性抗胆碱能药物对抑郁症患者抑郁评分的影响尚未得到充分研究。在之前一项为期4周的开放标签临床试验中，卡斯珀等人（1981年）报告称，比哌立登（安克痉）对抑郁症患者具有抗抑郁作用。我们在一项随机、双盲、平行设计的6周研究中对比了安慰剂和比哌立登的效果。所有患者在第一周接受安慰剂治疗，然后接受比哌立登（≤12毫克/天）或外周作用抗胆碱能药物格隆溴铵（胃长宁，1毫克/天）治疗4周。所有患者在第6周接受安慰剂治疗。两组患者均有显著改善，但与格隆溴铵相比，比哌立登未显示出任何显著优势。在接受比哌立登治疗的患者亚组中，与最初服用安慰剂的那一周相比，仅在服用比哌立登的第一周快速眼动睡眠百分比显著降低，这表明对比哌立登的中枢作用产生了耐受性。需要进一步研究以确定抗胆碱能药物是否具有抗抑郁特性。
