Litten R Z, Allen J P
Treatment Research Branch, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20852-7003, USA.
Psychopharmacology (Berl). 1998 Sep;139(1-2):20-33. doi: 10.1007/s002130050686.
Over the past decade, research on medications to treat alcohol problem has flourished. Naltrexone and acamprosate are tangible fruits of such endeavors and each has now earned approval in a large number of countries. Recent studies on naltrexone indicate that patient compliance is important if full benefits are to be achieved. Several laboratory studies with human subjects are beginning to elucidate the mechanisms underlying efficacy of naltrexone, as well as explaining variability of response among subpopulations of drinkers. In addition to these two agents, recent investigations have also demonstrated that the antidepressants desipramine, imipramine, and fluoxetine reduce mood-related symptoms and, to some extent, drinking itself in alcoholics who are depressed. Research to date suggests that opioid antagonists and selective serotonin reuptake inhibitors are more effective in reducing alcohol intake when used in combination. Clinical issues, methodology, and directions for future research are also reviewed in this article. In particular, issues addressed include alternative dosage regimens, necessary duration of treatment, employment of medications in combination, integration of pharmacologic agents with behavioral interventions, enhancement of patient compliance, and concurrent treatment of psychiatric comorbidity.
在过去十年中，用于治疗酒精问题的药物研究蓬勃发展。纳曲酮和阿坎酸就是这些努力的切实成果，目前它们在许多国家都已获得批准。近期对纳曲酮的研究表明，若要充分发挥其疗效，患者的依从性很重要。几项针对人类受试者的实验室研究开始阐明纳曲酮疗效的潜在机制，并解释饮酒者亚群体间反应的变异性。除了这两种药物，近期研究还表明，去甲丙咪嗪、丙咪嗪和氟西汀等抗抑郁药可减轻抑郁症酒精患者与情绪相关的症状，并在一定程度上减少其饮酒量。迄今为止的研究表明，阿片类拮抗剂和选择性5-羟色胺再摄取抑制剂联合使用时，在减少酒精摄入量方面更有效。本文还综述了临床问题、方法以及未来研究方向。特别涉及的问题包括替代给药方案、必要的治疗时长、联合用药、药物与行为干预的整合、提高患者依从性以及同时治疗合并的精神疾病。
