Blier P, Bergeron R
Department of Psychiatry, McGill University, Montréal, Québec, Canada.
J Clin Psychiatry. 1998;59 Suppl 5:16-23; discussion 24-5.
Serotonin (5-HT) selective reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors are thought to have a delayed onset of antidepressant action attributable in part to the decrease in firing activity of 5-HT neurons they produce upon treatment initiation. As cell body 5-HT1A autoreceptors desensitize, 5-HT neuronal firing is restored. The agent pindolol, through its 5-HT1A receptor blocking property, has been shown to prevent the initial decrease in firing of rat 5-HT neurons associated with SSRI treatment. Four open-label studies put into evidence a significant acceleration of the antidepressant effect of SSRIs when combined with pindolol. Four of five placebo-controlled studies have confirmed this observation. Controlled trials indicate that a greater rate of response may be obtained by combining pindolol from the beginning of the SSRI treatment. The strategy of adding pindolol to the regimen of SSRI-resistant patients also appears to produce a therapeutic effect in a significant proportion of patients.
血清素（5-羟色胺，5-HT）选择性再摄取抑制剂（SSRIs）和单胺氧化酶抑制剂被认为具有延迟的抗抑郁作用起效时间，这部分归因于治疗开始时它们所引起的5-HT神经元放电活动的降低。随着细胞体5-HT1A自身受体脱敏，5-HT神经元放电恢复。吲哚洛尔通过其5-HT1A受体阻断特性，已被证明可防止与SSRI治疗相关的大鼠5-HT神经元放电的初始降低。四项开放标签研究证明，与吲哚洛尔联合使用时，SSRIs的抗抑郁作用显著加速。五项安慰剂对照研究中的四项证实了这一观察结果。对照试验表明，从SSRI治疗开始就联合使用吲哚洛尔可能会获得更高的缓解率。在SSRI治疗无效的患者治疗方案中添加吲哚洛尔的策略似乎也能在相当一部分患者中产生治疗效果。
