Goldstein B J, Goodnick P J
Department of Psychiatry and Behavioral Sciences, Health Services Research Center, University of Miami School of Medicine, Florida 33136, USA.
J Psychopharmacol. 1998;12(3 Suppl B):S55-87. doi: 10.1177/0269881198012003041.
The clinical use of tricyclic antidepressants (TCAs) is often complicated by toxicity and safety problems due to their effects on multiple mechanisms of action, many of which are unnecessary for therapeutic effect. The development of the selective serotonin reuptake inhibitors (SSRIs), with their selective mode of action, has resulted in a class of antidepressant drugs possessing an improved side-effect profile, while retaining good clinical efficacy. Their introduction into clinical practice has led to enhanced patient compliance with antidepressant therapy and the ability to maintain treatment over longer periods of time at an adequate therapeutic dose. Although, as a result of their selective action, side-effects associated with SSRI therapy are minimised, distinct variations between individual SSRIs in terms of their tolerability profiles have been observed. The wealth of clinical data now available has revealed differences in their potential to cause psychiatric and neurological side-effects, dermatological reactions, anticholinergic side-effects, changes in body weight, sexual dysfunction, cognitive impairment, discontinuation reactions and drug-drug interactions. Patients who suffer from concomitant depression and physical illness may experience different tolerability profiles, in addition to the greater likelihood that they will be receiving concomitant medications with the potential for pharmacokinetic drug-drug interactions with coadministered SSRI therapy. In addition, the safety margin of SSRIs in overdose may vary within the group. Knowledge of the differences that exist among the SSRIs in respect of tolerability and safety will aid physicians in the selection of the most beneficial treatment strategy for their patients. A successful clinical outcome leads to a reduced economic burden for the patient, their family and the healthcare services. Thus, pharmacoeconomic considerations are also important in choosing antidepressant therapy. The SSRIs, despite relatively higher prescription costs, have been demonstrated to be a more cost-effective option than the TCAs. Furthermore, there is evidence that the emerging clinical differences between SSRIs may translate into significantly different economic outcomes within the group.
三环类抗抑郁药（TCAs）的临床应用常因对多种作用机制产生影响而出现毒性和安全性问题，其中许多机制对治疗效果并非必需。选择性5-羟色胺再摄取抑制剂（SSRIs）以其选择性作用模式得以研发，这类抗抑郁药副作用较小，同时保留了良好的临床疗效。它们应用于临床实践提高了患者对抗抑郁治疗的依从性，并能在足够的治疗剂量下维持较长时间的治疗。尽管由于其选择性作用，与SSRI治疗相关的副作用降至最低，但已观察到不同SSRI之间在耐受性方面存在明显差异。现有的大量临床数据显示，它们在引发精神和神经方面的副作用、皮肤反应、抗胆碱能副作用、体重变化、性功能障碍、认知障碍、停药反应及药物相互作用方面存在差异。患有抑郁症并伴有躯体疾病的患者可能会有不同的耐受性，此外，他们更有可能同时服用其他药物，这些药物与共同服用的SSRI治疗之间可能存在药代动力学药物相互作用。此外，过量服用时，SSRI的安全范围在该类药物中也可能有所不同。了解不同SSRI在耐受性和安全性方面的差异，将有助于医生为患者选择最有益的治疗策略。成功的临床结果会减轻患者、其家庭和医疗服务机构的经济负担。因此，药物经济学考量在选择抗抑郁治疗时也很重要。尽管SSRI的处方成本相对较高，但已证明其比TCAs更具成本效益。此外，有证据表明，SSRI之间新出现的临床差异可能转化为该类药物组内显著不同的经济结果。
