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抗抑郁症的六朵金花

2017-07-20 吴凯珊 逸仙药学V

目前。由于选择性5-羟色胺再摄取抑制剂 (SSRI 类) 对5-HT有高度选择性、对NE、多巴胺(DA)、组胺及胆碱能神经影响较小,口服吸收良好,生物利用度较高 ,耐受性好 ,依从性佳,适用于各种类型抑郁症。在世界各国均被作为抗抑郁药的首选。

据世界卫生组织报告:过去十年内全球受抑郁症影响的人数增加了18%。抑郁症在所有人群中都很常见,据估算,全球大约有3亿多人患有抑郁症,如果按人口比例来计算,占到全球人口的4.4%。

抑郁症是一种疾病,是一种以持久的抑郁心境为主要临床症状的一种精神障碍,临床表现以情绪低落、焦虑、迟滞和繁多的躯体不适症状为主,对愉快事物的兴趣丢失,有罪恶感或无价值感,甚至严重时产生自杀观念和行为。除了上述的典型症状外,抑郁症还有一系列的伴随症状,如精力减退、食欲改变、睡眠更多或更少、焦虑、注意力下降、躁动等。

抑郁症的病因和发病机制至今尚未完全阐明,按抑郁症的神经单胺改变来分析,中枢神经系统单胺类神经递质传递功能下降是抑郁症的主要病理改变。

治疗抑郁症的药物有许多,目前上市的抗抑郁药物主要见表1。




目前。由于选择性5-羟色胺再摄取抑制剂 (SSRI 类) 对5-HT有高度选择性、对NE、多巴胺(DA)、组胺及胆碱能神经影响较小,口服吸收良好,生物利用度较高 ,耐受性好 ,依从性佳,适用于各种类型抑郁症。在世界各国均被作为抗抑郁药的首选。

其中,SSRI 类的5个产品被我国精神医学界形象地称为 SSRI 类的“五朵金花”,它们分别是:氟西汀、帕罗西汀、舍曲林、氟伏沙明以及西酞普兰。而在2015年上市的艾司西酞普兰被喻为“第六朵金花”。

氟西汀(百忧解)



氟西汀主要适用于抑郁症及强迫症,并可作为神经性贪食症的治疗。氟西汀的起效较慢,有些患者甚至服用了6周才起效。

研究表明,氟西汀容易使人头痛、恶心和失眠,对性功能的影响比较大,因此,有失眠困扰的患者不适用氟西汀。氟西汀的停药通常会产生撤药症状,如头昏、感觉障碍,睡眠障碍,乏力等,因此,当氟西汀治疗需要停止时,建议逐渐地减少剂量。

氟西汀宜早上服用。

帕罗西汀(赛乐特)



帕罗西汀可治疗各类型的抑郁症,对伴有焦虑的抑郁症及反应性抑郁症疗效较好。

服用帕罗西汀的剂量通常是 20mg/日,服用后根据病人反应调整剂量,可每周以 10mg 量递增。根据国外经验,每天最大剂量可达 50mg。

同样,在停药的时候,也是每周逐渐减量。患者应治疗足够长时间以巩固疗效,抑郁症痊愈后应维持治疗至少几个月。

帕罗西汀有轻微抗胆碱作用,这是 SSRI 中唯一有抗胆碱作用的抗抑郁药。帕罗西汀不易产生兴奋性,对失眠的人,是一个较好的选择。帕罗西汀宜早上服用。

舍曲林(左洛复)



舍曲林适用于治疗抑郁症的相关症状,包括伴随焦虑、有或无狂躁史的抑郁症。舍曲林适合缺少快乐感的人,对运动和警觉性抑制相对来说较小。舍曲林尤为适宜女性和老年人。

由于舍曲林对多巴胺有再摄取抑制作用,它对性功能影响较小。

舍曲林每日一次给药,早或晚服用均可以。

氟伏沙明(兰释)



氟伏沙明是唯一有镇静作用的五羟色胺再摄取抑制剂,经常用于治疗伴焦虑和失眠的抑郁症患者。因此,氟伏沙明适合晚上服用,其有促进睡眠的作用。

由于氟伏沙明阻断五羟色胺回收较弱,故常需要较高剂量才能起效(100mg/d以上)。

氟伏沙明的性功能障碍率在 SSRI 是最低的。

西酞普兰(喜普妙)



西酞普兰对除5-羟色胺外的其他受体几乎没有亲和性,其选择性高,副作用也相对来说较少。西酞普兰在治疗忧郁症方面优于阿米替林,显效时间早,不良反应少而轻,尤其对心血管影响较少,是安全有效的抗抑郁药。

西酞普兰每日一次给药,可在一天的任何时候服用,不需要考虑食物摄入情况。

艾司西酞普兰

艾司西酞普兰高效、选择性、剂量依赖性抑制 SERT ,抑制在中枢神经系统神经末梢突触前膜5-HT的再摄取。

艾司西酞普兰起效快,治疗 1 周末就表现出显着疗效症状改善明显。

艾司西酞普兰作为一个新型抗抑郁药,在我国刚刚上市,还需要在临床实践中进一步验证和探索。

从总体上来说,这些 SSRI 类药物的疗效相近,这与它们的作用机制相似有关。这类药物的剂量—效应曲线平坦、意味着剂量增加,效应的变化很少。目前很难说哪种SRI类药物在总体上疗效好于另一种,在实际应用时,往往还要考虑多种因素,包括安全性、耐受性及费用等。需要注意的是,此类药物严禁与单胺氯化酶抑制剂 (如吗氯贝胺、司来吉兰、利奈唑胺等)合用,在停用单胺氧化酶抑制剂 14 天内也不能服用,因为可导致严重的副反应,有时是致命性的,这些病例类似于5-羟色胺综合征的表现。

原始出处:

[1] 林华华. 如何合理使用抗抑郁药[J]. 青海医药杂志, 2004, 34(10):  40-42.

[2] 诸索宇,施慎逊. 抗抑郁药的合理使用[J]. 上海医药, 2009, 30(10): 441-444.

[3] 彭碧苗,谢丽平. 浅谈抗抑郁药的合理使用[J]. 北方药学, 2011, 08(7): 72-73.

[4] 杨月明, 王瑜敖, 王立刚等. 抗抑郁药的不良反应及合理应用[J]. 中国药物评价, 2012, 29(5): 357-359.

[5]张慧光,钟松阳. 合理使用抗抑郁药应注意的几个问题[J]. 中国药业, 2006, 15(9): 52-53.

[6]王进良, 刘晓伟, 杨国平, 等. 西酞普兰治疗抑郁症临床观察[J]. 临床心身疾病杂志, 2007, 14(5): 43-44.

[7]司天梅, 舒良. 关于新抗抑郁药艾司西酞普兰司[J]. 临床精神药学杂志, 2007, 17(1): 68-69.

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    2017-07-20 惠映实验室

    学习了,谢谢

    0

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    2017-07-20 中医痴

    不错的,学习了,谢谢分享!

    0

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    2017-07-20 清风拂面

    很好的文章,谢谢分享

    0

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    2017-07-20 flysky120

    学习一下知识,解释说明非常好

    0

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    2017-07-20 186****0580(小山羊)

    学习了谢谢了。

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1492181, encodeId=43fc14921810a, content=<a href='/topic/show?id=7999553333c' target=_blank style='color:#2F92EE;'>#抗抑郁#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55333, encryptionId=7999553333c, topicName=抗抑郁)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a59b8920619, createdName=wushaoling, createdTime=Sat Jul 22 00:50:00 CST 2017, time=2017-07-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=224355, encodeId=0083224355b5, content=学习了,谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=110, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Thu Jul 20 19:48:31 CST 2017, time=2017-07-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=224254, encodeId=9c1f22425427, content=不错的,学习了,谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NdqKgfW3nMpOkC3jXxiaW2po0PtglY5ZuVjERqKADW4HyMI8bcZXWlKgH7tEP9ULBoBzuQMibia4pr1s9rQPqLvqQJ/0, createdBy=e8c02060444, createdName=中医痴, createdTime=Thu Jul 20 12:50:48 CST 2017, time=2017-07-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=224245, encodeId=69802242457d, content=很好的文章,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=114, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Thu Jul 20 12:30:05 CST 2017, time=2017-07-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=224221, encodeId=2f822242213b, content=学习一下知识,解释说明非常好, beContent=null, objectType=article, channel=null, level=null, likeNumber=110, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160718/IMG578C993D395567540.jpg, createdBy=59b81918946, createdName=flysky120, createdTime=Thu Jul 20 10:59:30 CST 2017, time=2017-07-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=224202, encodeId=b347224202bf, content=学习了谢谢了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLPeNmuNF9ibgMfMOAs7Iic5MpiaU8RLmRH67xCKuk5wzfhb7G4ib7ia6z9lrnsTicj1nAUfEOMecZDtvvu/0, createdBy=d7f91939785, createdName=186****0580(小山羊), createdTime=Thu Jul 20 10:22:50 CST 2017, time=2017-07-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=224201, encodeId=9f51224201e1, content=好恐怖,抑郁症患者这么多。, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzcjoLTEEgkSSQ8pVIiaf4a4INaoMLBV16QEk3dvvBRpicwIwmDGv0jePErJ4aE9ibVBDPtkialQLT9Bs/0, createdBy=04811949400, createdName=邓启付, createdTime=Thu Jul 20 10:15:36 CST 2017, time=2017-07-20, status=1, ipAttribution=)]
    2017-07-20 邓启付

    好恐怖,抑郁症患者这么多。

    0

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