New antidepressants

The chapter of pharmacotherapy of depression began around 1952 when Robitzek et al.¹ found that the taberculostatic drug isoniazid exerts an effect on mood, an observation which was confirmed by Flaherty.² In the same year, Zeller et al.³ demonstrated the monoamine oxidase inhibiting action of iproniazid. Soon after the antidepressant property of the iminodibenzyl derivative imipramine was recognized by Kuhn.⁴ Since then, a number of tricyclic antidepressants as well as monoamine oxidase preparations were introduced in rapid succession. All these drugs rightly called as the first generation antidepressants have been used with good therapeutic response over the past 25 to 30 yr. While the usefulness of these drugs have been well established over years, some of the shortcomings of the currently available drugs necessitated the search for better drugs.     

抗抑郁药的合并使用(英文)

难治性抑郁症是精神科医生面临的一个普遍问题。这些患者往往难以有效治疗。治疗难治性抑郁症患者的策略包括换药、增加另一种抗抑郁药(抗抑郁药联合治疗)以及抗抑郁药以外的增效治疗。     

Second-generation antipsychotic medications in children and adolescents

OBJECTIVE: We reviewed available pediatric literature on second-generation antipsychotic medications to assess current evidence of efficacy and safety. METHOD: An English language MEDLINE search (1974-2003) was conducted using key words-atypical antipsychotics, children and adolescents, toxicity, clozapine, risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole. Additional efficacy and safety data were obtained from drug manufacturers. RESULTS: We identified 176 reports, including 15 double-blind, controlled trials, 58 openlabel studies, 18 retrospective chart reviews, and 85 case series/reports. The majority of these studies (43%) were of risperidone. Evidence suggests that second-generation antipsychotics are efficacious in the treatment of psychosis, bipolar disorders, pervasive developmental disorders, and Tourette's Disorder, and are potentially useful in mental retardation, conduct disorder, and severe attention deficit hyperactivity disorder (ADHD). The most frequently reported side effects included cardiovascular effects, weight gain, sedation, sialorrhea, extrapyramidal signs, and hyperprolactinemia, although the relative frequencies of these untoward effects vary among medications. CONCLUSION: Although the evidence base for pediatric use of second-generation antipsychotics is expanding, the majority of available studies are anecdotal, or short-term, openlabel trials. Reports suggest that these compounds are effective for a variety of psychiatric disorders in children and adolescents, but additional double-blind, controlled studies are required to establish definitive efficacy. Although these medications appear to be well tolerated in short-term studies, long-term follow-up investigations and ongoing clinical monitoring are necessary to confirm their safety in this age group.     

Antipsychotics as antidepressants

Three second‐generation antipsychotic (SGA) agents have received FDA approval for adjunctive treatment, to antidepressant, of major depressive disorder: quetiapine, aripiprazole, and olanzapine. Additionally, quetiapine and lurasidone have been approved for the treatment of bipolar depression. There are data suggesting that quetiapine is effective for major depressive disorder as monotherapy. These agents are effective for depression only at subantipsychotic doses. Receptor profiles predict that all SGA will have anxiolytic effects as subantipsychotic doses but that all will be dysphorogenic at full antipsychotic doses (i.e., produce a depression‐like clinical picture). The antidepressant effect appears to be unique to some agents, with direct evidence of insignificant antidepressant action for ziprasidone. Three general principles can guide the use of antipsychotics as antidepressants: (i) All SGAs may have anxiolytic effects; (ii) full antipsychotic doses are dysphorogenic, and therefore, subantipsychotic doses are to be used; and (iii) SGAs do not have a general antidepressant effect, rather, this appears to be unique to quetiapine and aripiprazole, and possibly lurasidone.     

三环抗抑郁药的相互作用

<正>在抗抑郁药的使用频度中,三环抗抑郁药(TCAs)之所以日渐向后排,不是因为它疗效不好,而是因为它不良反应大,不易耐受,过量时危险性大,故医生在使用TCAs期间,不但要掌握TCAs药效学,而且要熟悉TCAs的药物相互作用,这里将专门讨论TCAs的药物相互作用。1概论多数精神药物主要经肝细胞色素P450单氧合酶(CYP)代谢,称为Ⅰ相氧化代谢;次要经葡萄糖醛     

抗抑郁药的研究进展

<正>抑郁症已经成为一种高发病率和高死亡率的疾病,预计在2020年将会成为影响人类健康的第二类疾病[1]。抑郁症是遗传和环境因素共同引起的,机制可能是诱发中枢5-羟色胺(5-HT)或去甲肾上腺素(NE)、多巴胺(DA)和神经肽等神经递质含量降低及其受体功能下降有关,近年来还有发现可能与下丘脑-垂体-肾上腺轴负反馈失调[2]、谷氨酸传导障碍[3]、神经免疫异常[4]等因素有关。目