SSRI和SNRI疗效相当,耐受性更好.pptx

SSRI和SNRI疗效相当，耐受性更好内部资料，仅供医学药学专业人士参考，严禁翻印及传播产品具体使用方法、不良反应、注意事项、禁忌症详见说明书抑郁症的发病机制和SSRI的药理机制中枢5-HT功能低下是抑郁症的主要病理机制中枢5-HT的代谢：5-HT转运体重新吸收位于突触间隙的5-HT，发挥再摄取作用。正常人的5-HT神经递质与受体处于平衡状态。抑郁的发生与突触间隙的5-HT浓度降低有直接相关。正常人抑郁症患者National Institute of Mental Health. The Science of Mental Illness. 2005. P29.SSRI类药的作用机制：选择性抑制5-HT再摄取Other peripheral mediators: 5-hydroxytryptamine and purines. In: Pharmacology, 4th edition. Rang HP, Dale MM and Ritter JM. Edinburgh, UK: Harcourt Publishers Ltd, 2001:165–176.艾司西酞普兰双重结合5-HT转运体，抑制5-HT再摄取说明：5-HT转运蛋白上存在基本位点和异构位点。常见的SSRI类药物仅结合基本位点而发挥5-HT再摄取抑制作用。艾司西酞普兰不仅结合基本位点，还可以与异构位点结合。艾司西酞普兰的双重结合作用使之与5-HT转运蛋白的结合增强。5-HT转运体Sánchez C. The pharmacology of citalopram enantiomers: the antagonism by R-citalopram on the effect of S-citalopram. Basic Clin Pharmacol Toxicol. 2006;99:91-95Sanchez, Br?strup. Escitalopram: a unique mechanism of action. Int J Psych Clin Pract 2004;8(suppl):11-3Sánchez et al. Escitalopram versus citalopram: the surprising role of the R-enantiomer. J Psychopharmacol 2004;174: 163–176 国际抑郁焦虑障碍治疗指南均推荐SSRI为一线治疗药物SSRI类药是抑郁障碍的一线治疗药国际指南建议描述APA(2010)大多数患者的理想选择是SSRI、SNRI、米氮平或安非他酮For most patients, a selective serotonin reuptake inhibitor (SSRI), serotonin norepinephrine reuptake inhibitor (SNRI), mirtazapine,or bupropion is optimal [I].NICE(CG91,2010)通常SSRI是慢性躯体疾病伴发抑郁症患者的一线治疗Generally, SSRIs should be first-line treatment for depression in people with a chronic physical health problem.NICE(CG90,2009)当需要处方抗抑郁药时，正常情况下是选择SSRIWhen an antidepressant is to be prescribed, it should normally be an SSRICANMAT（2009）SSRI、SNRI和新型药物是一线治疗。selective serotonin reuptake inhibitors (SSRIs), serotonin and noradrenaline reuptake inhibitors (SNRIs), and newer agents were first-line medicationsAPA=美国精神病学会，NICE=英国健康与临床优化研究所，CANMAT=加拿大抑郁焦虑治疗协作网，SSRI类药是焦虑障碍的一线治疗药物焦虑障碍指南/专家组推荐治疗方法推荐最短治疗时间PDAPACBT或药物治疗12-18个月NICE首选SSRIs有效后，继续治疗6个月CANMAT，ICGDASSRIs及其它12-24个月GADNICE首选SSRIs有效后，继续治疗6个月CANMATSSRIs及其它12-24个月ICGDASSRIs, SNRIs, TCA和CBT12个月到终生用药SADCANMATSSRIs及其它12-24个月ICGDASSRIs12个月PTSDCAN