Cohen L J
Oklahoma Department Human Services/DDSD, University of Oklahoma Health Sciences Center, Oklahoma City, USA.
Pharmacotherapy. 1997 Jan-Feb;17(1):45-61.
New drugs are being developed for the management of depression in response to the growing awareness of the prevalence and disability associated with the disorder and the need for agents with improved side effect profiles. All antidepressants are equally effective for treating uncomplicated unipolar depression without psychotic features. For patients with atypical depression with prominent anxiety, agitation, sleep loss, and irritability, monoamine oxidase inhibitors are the first choice. Data are accumulating supporting the efficacy of selective serotonin reuptake inhibitors (SSRIs) in these depressive subtypes. Factors to consider when choosing an antidepressant include spectrum of adverse effects, long-term tolerability, dosing schedule, clinically significant drug interactions, underlying medical conditions, earlier response to therapy, and pharmacoeconomics. Based on these criteria, it is suggested that a trial with the SSRIs be attempted first. Venlafaxine and nefazodone are newer agents with mechanisms of action that have advantages over tricyclic antidepressants and monoamine oxidase inhibitors. Choosing a drug that is effective, tolerable, and convenient will improve the likelihood of achieving and maintaining a full remission. It will also decrease the morbidity and mortality of this very treatable disease.
随着人们对抑郁症患病率及相关残疾问题的认识不断提高，以及对副作用较小药物的需求增加，新型抗抑郁药物正在研发中。所有抗抑郁药在治疗无精神病性特征的单纯性单相抑郁症方面同样有效。对于伴有明显焦虑、激动、失眠和易怒等非典型抑郁症患者，单胺氧化酶抑制剂是首选。越来越多的数据支持选择性5-羟色胺再摄取抑制剂（SSRI）在这些抑郁亚型中的疗效。选择抗抑郁药时需要考虑的因素包括不良反应范围、长期耐受性、给药方案、具有临床意义的药物相互作用、基础疾病、对治疗的早期反应以及药物经济学。基于这些标准，建议首先尝试使用SSRI进行试验。文拉法辛和奈法唑酮是新型药物，其作用机制优于三环类抗抑郁药和单胺氧化酶抑制剂。选择一种有效、耐受性好且方便的药物将提高实现并维持完全缓解的可能性。这也将降低这种完全可治疗疾病的发病率和死亡率。
