Pharmacologic alternatives to antidepressants in posttraumatic stress disorder: a systematic review.
Pharmacologic alternatives to antidepressants in posttraumatic stress disorder: a systematic review.
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DOI：
10.1016/j.pnpbp.2008.12.004
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发表时间：
2009-03-17
影响因子：
5.6
通讯作者：
Figueira, Ivan
中科院分区：
文献类型：
--
作者：
Berger, William;Mendlowicz, Mauro V.;Marques-Portella, Carla;Kinrys, Gustavo;Fontenelle, Leonardo F.;Marmar, Charles R.;Figueira, Ivan
选择性血清素再摄取抑制剂（SSRI）被认为是治疗 PTSD 的一线药物。然而，即使使用此类药物治疗，缓解率也很少超过 60%，只有不到 20-30% 的患者达到完全缓解。本研究的目的是通过系统地审查当患者对 SSRI 反应不令人满意或无法耐受 PTSD 时留下的治疗 PTSD 的选择来解决这一局限性。通过在 ISI/Web of Science、PubMed 和 PILOTS 数据库中进行检索，对 2008 年 10 月之前以任何语言发表的所有原始文章、信件和简短报告进行了系统回顾。搜索词包括每种药物的药理学类别或其通用名称以及标题、摘要或关键词中的“PTSD”或“应激障碍”。共选出 63 篇文章，涵盖以下类别：抗精神病药、抗惊厥药、肾上腺素能抑制剂、阿片类拮抗剂、苯二氮卓类药物和其他药物。所确定的药物均未达到 A 级科学证据，5 种达到 B 级，7 种达到 C 级，13 种达到 D 级。最有力的科学证据支持其在 PTSD 中使用的非抗抑郁药物是利培酮，当患者未从先前的 SSRI 治疗中完全受益时，可以将其视为一种有效的附加疗法。哌唑嗪是一种肾上腺素能抑制剂，对于以噩梦和失眠为突出症状的创伤后应激障碍 (PTSD) 病例来说，是一种很有前途的替代药物。到目前为止，对于使用苯二氮卓类药物预防或治疗创伤后应激障碍（PTSD）还没有一致的经验支持，尽管这些药物可以减轻一些相关的非特异性症状，例如失眠或焦虑。需要进一步的对照临床试验和荟萃分析来指导临床医生寻找治疗创伤后应激障碍（PTSD）抗抑郁药的有效药理学替代品。
The selective serotonin reuptake inhibitors (SSRIs) are considered the first-line pharmacological treatment for PTSD. However, even when treated with this class of drugs, response rates rarely exceed 60% and less than 20–30% of the patients achieve full remission. The aim of this study was to address this limitation by systematically reviewing the options left for the treatment of PTSD when patients do not respond satisfactorily to or tolerate SSRIs. A systematic review covering all original articles, letters and brief reports published in any language until October 2008 was conducted through searches in the ISI/Web of Science, PubMed and PILOTS databases. The search terms included the pharmacological class of each agent or its generic name plus “PTSD” or “stress disorder” in the title, in the abstract or as a keyword. Sixty-three articles were selected, covering the following categories: antipsychotics, anticonvulsants, adrenergic-inhibiting agents, opioid antagonists, benzodiazepines and other agents. None of the identified agents reached the level A of scientific evidence, 5 reached level B, 7 level C and 13 level D. The non-antidepressant agent with the strongest scientific evidence supporting its use in PTSD is risperidone, which can be envisaged as an effective add-on therapy when patients did not fully benefit from previous treatment with SSRIs. Prazosin, an adrenergic-inhibiting agent, is a promising alternative for cases of PTSD where nightmares and insomnia are prominent symptoms. So far, there is no consistent empirical support for using benzodiazepines in the prevention or in the treatment of PTSD, although these drugs could alleviate some associated non-specific symptoms, such as insomnia or anxiety. Further controlled clinical trials and meta-analysis are needed to guide clinicians in their search of effective pharmacological alternatives to antidepressants in PTSD.
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