POSSIBLE ANTIDEPRESSIVE EFFECTS OF OPIOIDS - ACTION OF BUPRENORPHINE
POSSIBLE ANTIDEPRESSIVE EFFECTS OF OPIOIDS - ACTION OF BUPRENORPHINE
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DOI：
10.1111/j.1749-6632.1982.tb39483.x
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发表时间：
1982-01-01
影响因子：
5.2
通讯作者：
HERZ, A
中科院分区：
文献类型：
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作者：
EMRICH, HM;VOGT, P;HERZ, A
鸦片类药物和内啡肽的兴奋和缓解焦虑的特性*引发了人们的疑问，即有缺陷的内啡肽能系统可能代表了内源性抑郁症发病的一个致病因素。尽管来自生化和药理学数据，但支持这一假说的证据很弱(参见。裁判3)然而，它需要额外的评估。然而，无论在抑郁症患者的治疗中是否存在内源性吗啡类物质的假说体质缺陷，通过外源性供应来弥补，问题是，是否独立于抑郁症中这种可能的代谢功能障碍，在抑郁症综合征中存在阿片类药物的直接药效学治疗作用。由于焦虑和睡眠障碍，除了忧郁症之外，还构成了抑郁症的精神病理学的一个组成部分，从它们的行动概况来看，可以预见阿片类药物在治疗抑郁症方面可能非常有效。“鸦片疗法”已被推荐用于抑郁症患者的治疗，采用缓慢增加和后来减少剂量的鸦片酊剂和其他阿片类药物。B有趣的是，根据当时的报告，尽管过去和现在都缺乏对治疗效果的标准化评估，但这种治疗是有效的，可能没有导致阿片成瘾，因为应用的剂量相对较低。后来，芬克等人。7在10例重度抑郁症患者中应用激动剂/拮抗剂环唑西汀(1.0-3.0 mg)，观察到较强的抗抑郁作用，尤其是对“抑郁情绪”和“淡漠”项的抗抑郁作用。对阿片类药物可能有益作用的进一步临床评估已被推迟，这可能是由于环唑类药物的拟精神作用，此外，鉴于三环类抗抑郁药和MAO抑制剂的发现开启了抑郁综合征药物治疗的新纪元。有趣的是，内啡肽的发现为阿片受体的激活可能带来的精神影响提供了新的线索，在评估阿片类药物可能的抗抑郁作用方面立即开始了新的尝试。Kline et A1.*是第一个通过使用/3-内啡肽(1.5-6.0毫克)输注对不同类型的精神障碍(精神分裂症、抑郁症、神经症)进行临床试验的人，并在两名抑郁症患者中以开放设计观察了这种治疗的积极效果。8在一项公开试验中，Anst et A1调查了注射10毫克B-内啡肽可能的抗抑郁作用，并在6名抑郁患者中的3名患者中检测到转换为轻躁狂/躁狂。随后，关于内啡肽可能的抗抑郁效果的双盲试验已经完成。
The euphorogenic and anxiolytic properties of opiates and of endorphins* prompt questions as to the possibility that a defectively operating endorphinergic system may represent a causative factor in the pathogenesis of endogenous depression. Though from biochemical and pharmacological data the evidence in support of this hypothesis is weak (cf. ref. 3) it, nevertheless, requires additional evaluation. However, irrespective of the presence of a hypothetical constitutional deficit of endogenous morphinomimetic substances compensated for by an exogenous supply in the therapy of depressed patients, the question arises if, independently from such a possible type of metabolic dysfunction in depression, there may exist direct pharmacodynamic therapeutic effects of opioids in depressive syndromes. Since anxiety and sleep disturbances, in addition to melancholia, make up an integral part of the psychopathology of depression, from their profile of action, it may be anticipated that opioids could be highly effective, therapeutically, in depressive illness. the “opium cure” has been recommended for the treatment of depressed patients, employing slowly increasing and later decreasing dosages of tinctura opii and of other opiates. B Interestingly, according to reports of that time, although a standardized evaluation of the therapeutic efficacy was, and is, lacking, this treatment was effective and did not result in opiate addiction, possibly, since the doses applied were comparatively low. Later, Fink et al. 7 applied the mixed agonist/antagonist cyclazocine (1.0-3.0 mg) in 10 severely depressed patients and observed a strong antidepressive effect, in particular concerning the items “depressed mood” and “apathy.” A further clinical evaluation of possible beneficial effects of opiates has been deferred, possibly owing to the psychotomimetic effects of cyclazocine and, furthermore, in view of the fact that the discovery of tricyclic antidepressants and of MAO-inhibitors opened a new era in the pharmacotherapy of depressive syndromes. Interestingly, immediately after the discovery of the endorphins, which shed new light onto the possible psychotropic effects of an activation of opiate receptors, new attempts were initiated in the evaluation of the possible antidepressive effects of opioids. Kline et a1.* were the first to perform clinical trials in different types of psychiatric disorders (schizophrenia, depression, neuroses) by use of/3-endorphin infusions (1.5-6.0 mg) and observed in two depressed patients, in an open design, positive effects of this treatment. Angst et a1., 8 also in an open trial, investigated the possible antidepressive action of infusions of 10 mg of B-endorphin and detected a switch to hypomania/mania in three of six depressed patients. Subsequently, doubleblind trials as to the possible antidepressant efficacy of &endorphin have been