Delgado P L, Moreno F A
Department of Psychiatry, University of Arizona College of Medicine, Tucson 85274, USA.
Br J Psychiatry Suppl. 1998(35):21-5.
There is a major role for serotonin in the mechanism of anti-obsessional drug action. Drugs that block uptake of noradrenaline are not effective in the treatment of obsessive-compulsive disorder (OCD), while drugs that potently bock serotonin reuptake are effective. While enhancement of serotonin neurotransmission is clearly involved in the treatment of OCD, the role of serotonin in the pathophysiology of OCD is less clear.
This paper provides a brief, focused review of the literature regarding treatment of OCD, the effects of drugs with selective action at various serotonin receptors and results of neurotransmitter depletion studies in patients with OCD.
Some patients with OCD may experience remission of OCD symptoms during intoxication with psychedelic drugs that have potent 5-HT2A/2C agonist activity. These findings, coupled with results from serotonin depletion studies in depressed and OCD patients, suggest that enhancement of serotonin neurotransmission may underlie both antidepressant and anti-obsessional drug action, although the targeted brain areas may differ.
OCD may not involve a dysfunction of the serotonin system. Rather, it is more likely to involve a dysfunction of specific brain circuits, particularly in the frontal cortex. Modulation of these circuits by serotonin neurons may underlie the specific action of anti-obsessional drugs.
血清素在抗强迫药物作用机制中起主要作用。阻断去甲肾上腺素摄取的药物对强迫症（OCD）治疗无效，而强效阻断血清素再摄取的药物则有效。虽然血清素神经传递增强显然与强迫症治疗有关，但血清素在强迫症病理生理学中的作用尚不清楚。
本文对有关强迫症治疗、对各种血清素受体具有选择性作用的药物的效果以及强迫症患者神经递质耗竭研究结果的文献进行了简要、重点突出的综述。
一些强迫症患者在服用具有强效5-HT2A/2C激动剂活性的致幻药物中毒期间，强迫症症状可能会缓解。这些发现，再加上对抑郁症患者和强迫症患者进行的血清素耗竭研究结果，表明血清素神经传递增强可能是抗抑郁药和抗强迫药物作用的基础，尽管靶向的脑区可能不同。
强迫症可能不涉及血清素系统功能障碍。相反，它更可能涉及特定脑回路功能障碍，特别是额叶皮质。血清素神经元对这些回路的调节可能是抗强迫药物特定作用的基础。
