讲课抑郁药物PPT.ppt

* * 抗抑郁药的选用 既往用药史 药物遗传学 药物的药理学特征 可能的药物间相互作用 病人躯体状况和耐受性 抑郁亚型 可获得性及价格 停药综合症 TCAs的心血管副作用 过量中毒 药物相互作用 肝功受损病人小心使用 中枢5-HT综合征 注意事项 * * * * 换药后约50%的病人有效 转换 有效率 SSRI to TCA 46-73% SSRI to 其它 SSRI 50-60% SSRI to 文拉法辛 33-70% SSRI to丁氨苯丙酮 56% SSRI to米氮平 67% Howland RH, Thase M. J Pract Psych 1999; 5:216-23 * * Flu-like symptoms 感冒样症状 Insomnia 失眠 Nausea 恶心 Imbalance 平衡失调 Sensory Disturbances 感觉障碍 Hyperarousal (agitation) 唤醒过度（激越） F I N I S H Berber M, et al., J Clin Psych 1998;59:5 抗抑郁药撤药综合征 * * 抗抑郁药出现撤药综合征的风险 Reesal R. The Canadian Journal of Diagnosis, Nov 1999 中 氟伏沙明 高 帕罗西汀 文拉法辛 TCAs MAOIs 低 西酞普兰 氟西汀 舍曲林 丁氨苯丙酮 米氮平 * * 感谢您的聆听！ * * Antidepressants c. 1999 Today, we have a vast multitude of antidepressants available. In addition to the tricyclic antidepressants (TCA), and the monoamine oxidase inhibitors (MAOI) the following agents are now available: Reversible inhibitor of monoamine oxidase (RIMA) Selective serotonin reuptake inhibitor (SSRI) Serotonin antagonist and reuptake inhibitor (SARI) Serotonin and noradrenergic reuptake inhibitor (SNRI) Noradrenergic and serotonin agonist (NaSSA) (?) Noradrenergic and dopamine reuptake inhibitor (NDRI) Norepinephrine reuptake inhibitor (NRI) * * * The “cleaner” the drug, the better the side effect profile. Agents that have greater affinities to multiple receptors will, by definition, run a greater risk of creating unwanted side effects. This slide shows the relationship between neurotransmitter affinity, receptor activity and clinical side effects. * * * 心血管系统的临床意义：合并冠心病者，高血压者、老人、低血压者等 锥体外系反应：老人 镇静作用：职业工作者、驾驶人员、精密工作者 抗胆碱能作用：老人 * Weight gain during antidepressant treatment can either be a sign of improvement in patients who have weight loss as a symptom of depression or as a residual symptom in patients who overeat when depressed. However, significant weight gain during the acute phase of treatment or weight gain that continues despite achieving full remission of depressive symptoms is likely to be a side effect of antidepr