Richelson E
Department of Psychiatry and Pharmacology, Mayo Medical School, Rochester, Minn, USA.
J Clin Psychiatry. 1998;59 Suppl 10:22-6.
Seven of the newest antidepressants are the serotonin selective reuptake inhibitors (fluoxetine, sertraline, paroxetine, and fluvoxamine [currently approved in the United States for obsessive-compulsive disorder only]), a serotonin norepinephrine reuptake inhibitor (venlafaxine), a postsynaptic serotonin antagonist/presynaptic serotonin reuptake inhibitor (nefazodone), and presynaptic/postsynaptic noradrenergic/serotonergic receptor antagonist (mirtazapine). Many of these drugs are potent inhibitors of the cytochrome P450 (CYP) enzymes of the liver. The CYP enzymes most relevant to the use of antidepressants and for which the most thorough data are available are the CYP1A2, CYP2D6, and CYP3A4. These 3 CYP isoenzymes are discussed in relation to some of the drugs they metabolize, and appropriate cautions are recommended for concurrent administration of these new antidepressants and other drugs frequently prescribed to elderly patients.
七种最新的抗抑郁药包括5-羟色胺选择性再摄取抑制剂（氟西汀、舍曲林、帕罗西汀和氟伏沙明[目前在美国仅被批准用于强迫症]）、一种5-羟色胺去甲肾上腺素再摄取抑制剂（文拉法辛）、一种突触后5-羟色胺拮抗剂/突触前5-羟色胺再摄取抑制剂（奈法唑酮）以及一种突触前/突触后去甲肾上腺素能/5-羟色胺能受体拮抗剂（米氮平）。这些药物中有许多是肝脏细胞色素P450（CYP）酶的强效抑制剂。与抗抑郁药使用最相关且有最全面数据的CYP酶是CYP1A2、CYP2D6和CYP3A4。将针对它们代谢的某些药物讨论这三种CYP同工酶，并针对这些新型抗抑郁药与老年患者常用的其他药物联合使用提出适当的注意事项。
