抑郁症药物治疗最新研究进展情况.ppt

* The mechanism of action of TCAs is that they work mainly on the NA and 5-HT system although they also have affinity for other neuronal systems like the dopaminergic, muscarinic and histaminergic system. By inhibiting the re-uptake of noradrenaline and serotonin, the concentration in both synaptic clefts increases, consequently enhancing the increase of neurotransmission activity. * The mechanism of action of SSRIs is based on a selective inhibition on the re-uptake of serotonin. SSRIs differ within their class with regard to the affinity for other neuronal systems like the dopaminergic, muscarinic and histaminergic system. By inhibiting the re-uptake of serotonin the concentration in the synaptic cleft increases, consequently enhancing the increase of neurotransmission activity on all postsynaptic receptors. * The mechanism of action of SNRIs is most comparable to that of TCAs. They act mainly on the NA and 5HT system by re-uptake inhibition but there is little to no affinity for other neuronal systems like the dopaminergic, muscarinic and histaminergic system. By inhibiting the re-uptake of noradrenaline and serotonin the concentration in both synaptic clefts increases resulting in increasing neurotransmission activity, although this may only occur in higher doses. * References: - Pinder RM, J Clin Psychiatry 1997; 58(11): 501-508 - Den Boer Th., J Clin Psychiatry 1996; 57 (suppl 4): 19-25 米氮平通过阻断?2-肾上腺素能自身受体，提升去甲肾上腺素传递。此外，米氮平通过2种具有协同作用的机制提升5羟色胺能传递： 1. 增加去甲肾上腺素供量，刺激5羟色胺能细胞体上的?1-异质受体，从而增加5-HT 细胞点燃 2. 阻断 ?2-肾上腺素能异质受体。 米氮平特异性提升 5-HT1介导的传递，因为米氮平阻断 5-HT2 和 5-HT3 受体。 （ SNRI）文拉法新----选择性NA和5-HT重吸收抑制剂 （75mg/d=SSRI,75-150mg/d=SNRI,150mg/d=SNDRI） noradrenaline increase in neurotransmission re-uptake pump serotonin SNRI Ⅹ Ⅹ ↓ ↓ ↓ ↓ little to no affinity for other neuronal systems like the dopaminergic, muscarinic and histaminergic system 文拉法辛的特点 起效快，服用后2周内即见效。有明显的抗抑郁及抗焦虑作用。有速效剂和缓释剂两种。 推荐剂量:治疗剂量为75－300mg/d,一般为150－200mg/d,分2－3次服。缓释剂每粒75/150mg,有效剂量75-300mg/d，日服一次 适应症 主要为