SEROTONIN-INFLUENCING DRUGS IN THE TREATMENT OF PANIC DISORDER
SEROTONIN-INFLUENCING DRUGS IN THE TREATMENT OF PANIC DISORDER
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DOI：
10.1159/000284628
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发表时间：
1989-01-01
期刊：
影响因子：
3.6
通讯作者：
WESTENBERG, HGM
中科院分区：
文献类型：
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作者：
WESTENBERG, HGM
临床和临床前数据表明5-羟色胺（5-HT）功能与焦虑症的某些精神病理学维度之间存在联系。抗抑郁药一直被发现对焦虑症，特别是恐慌症有良好的效果。5-HT-选择性药物的临床研究表明，5-HT神经元可能包括抗焦虑药物发挥其作用的显着比例的网站。因此，氟伏沙明，一种选择性5-HT摄取抑制剂，而不是马普替林，一种选择性去甲肾上腺素摄取抑制剂，被认为是有效的惊恐障碍。氟伏沙明的临床效果显示了一个值得注意的时间过程。焦虑在最初增加之后，逐渐得到改善。基于这一发现，我们初步假设，由摄取抑制引起的5-HT受体的刺激将使患者的病情恶化，而由长期治疗引起的5-HT受体的下调将解释临床疗效。因此，我们进行了一项研究，其中利坦色林，一个假定的5-HT？拮抗剂，与氟伏沙明进行了比较。发现利坦色林在治疗惊恐障碍症状中无效，这表明5-HT 2受体可能并不关键地参与5-HT摄取抑制剂的抗焦虑活性的机制。因此，其他5-HT受体亚型，如5-HT，.可能与这种影响有关。选择性5-HT的最新研究|激动剂支持这一假设。
Clinical and preclinical data suggest a link between serotonin [5-hydroxytryptamine (5-HT)] function and certain psychopathologic dimensions of anxiety disorders. Anti depressants consistently have been found to exert a favorable effect in anxiety disorders, particularly panic disorders. Clinical studies with 5-HT-selective drugs have shown that 5-HT neurons may comprise the site at which anxiolytic drugs exert a significant proportion of their action. Thus, fluvoxamine, a selective 5-HT uptake inhibitor, but not maprotiline, a selective noradrenaline uptake inhibitor, was found to be efficacious in panic disorder. The clinical effect of fluvoxamine revealed a noteworthy time course. After an initial increase in anxiety, improvement was attained gradually. On the basis of this finding, we tentatively hypothesized that stimulation of the 5-HT receptors, resulting from uptake inhibition, would worsen the condition of the patient, while down-regulation of the 5-HT receptors, resulting from chronic treatment, would account for the clinical efficacy. Thus, we performed a study in which ritanserin, a putative 5-HT? antagonist, was compared with fluvoxamine. Ritanserin was found to be ineffective in the treatment of panic disorder symptoms, suggesting that 5-HT2 receptors may not be critically involved in the mechanism underlying the anxio lytic activity of 5-HT uptake inhibitors. It would seem, therefore, that other 5-HT-receptor subtypes, eg, 5-HT,. may be implicated in this effect. Recent studies with selective 5-HT| agonists support this hypothesis.