Dunner D L
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle 98105, USA.
Int Clin Psychopharmacol. 1998 Apr;13 Suppl 4:S19-24. doi: 10.1097/00004850-199804004-00004.
Both depression and panic disorder are found commonly in community surveys and it is not unexpected that there should be a co-occurrence of these disorders in some patients. However, recent data suggest that there is a greater clustering of depression among panic disorder patients and panic disorder among depressed patients than one might expect by chance alone. For example, further analysis of data from the National Comorbidity Survey indicates that there is a history of major depression in 55.6% of subjects with lifetime panic disorder and that 21.6 % of depressed patients experience a panic attack at some time in their lives. The high incidence of comorbidity of panic and major depressive disorders emphasizes the value of pharmacotherapy with a broad-spectrum agent that can treat the symptoms of comorbid psychiatric disorders effectively. Of the therapeutic options available, there is mounting evidence that selective serotonin reuptake inhibitors (SSRIs) represent reasonable monotherapy for patients with comorbid depression and panic disorder, based on the equivalent efficacy and improved side-effect profiles compared with other classes of antidepressant. The clinical relevance of differences in the pharmacokinetic and clinical profiles of SSRIs have been discussed in the context of treatment strategies for the patient with comorbid depression and panic disorder.
在社区调查中，抑郁症和惊恐障碍都很常见，因此在一些患者中这两种疾病同时出现并不意外。然而，最近的数据表明，惊恐障碍患者中抑郁症的聚集程度以及抑郁症患者中惊恐障碍的聚集程度，比仅靠偶然因素预期的要高。例如，对全国共病调查数据的进一步分析表明，在患有终生惊恐障碍的受试者中，55.6%有重度抑郁症病史，而21.6%的抑郁症患者在其生命中的某个时候会经历惊恐发作。惊恐障碍和重度抑郁症共病的高发生率强调了使用能有效治疗共病精神障碍症状的广谱药物进行药物治疗的价值。在现有的治疗选择中，越来越多的证据表明，与其他类别的抗抑郁药相比，选择性5-羟色胺再摄取抑制剂（SSRI）基于同等疗效和更好的副作用谱，对共病抑郁症和惊恐障碍的患者来说是合理的单一疗法。在共病抑郁症和惊恐障碍患者的治疗策略背景下，已经讨论了SSRI在药代动力学和临床特征方面差异的临床相关性。
