Comb Dopamine Agonist & Select Serotonin Reuptake Inhibitor f/Trtmt of Depression

临床前和临床研究表明，联合作用机制的抗抑郁药（例如，选择性5 -羟色胺再摄取抑制剂（SSRI）和去甲肾上腺素再摄取抑制剂的组合）在实现缓解方面可能比单独使用任何一种药物更有效（Nelson et al . 2004）。因此，有理由认为，具有其他作用机制的抗抑郁药的其他组合在联合使用时可能具有协同效应，优于具有单一作用机制的抗抑郁药。临床前和临床研究表明，多巴胺能系统可能在抑郁症的病理生理中发挥重要作用。临床前研究表明，在抑郁症动物模型中，SSRI和选择性D3受体激动剂联合使用具有协同抗抑郁作用。同样，初步临床研究表明，联合治疗可以影响血清素和多巴胺系统。总之，这些数据表明，影响血清素和多巴胺系统的治疗将比使用单一机制的药物更有效。我们目前正在比较选择性多巴胺能激动剂和SSRI在治疗难治性重度抑郁症患者中的联合应用。本研究仍在进行中，并积极招募受试者。由于研究尚未完成，研究结果尚未公布。据我们所知，这是迄今为止唯一一项检查从治疗开始就给予血清素和多巴胺组合效果的对照双盲研究。

Preclinical and clinical studies suggest that antidepressants with a combined mechanism of action (e.g., combination of a selective serotonin-reuptake inhibitor (SSRI) and a norepinephrine reuptake inhibitor) may be more effective than either agent alone in achieving remission (Nelson et al 2004). Thus, it stands to reason that other combinations of antidepressants with other mechanisms of action when combined may have a synergistic effect that is superior to an antidepressant with a single mechanism of action. Preclinical and clinical studies suggest that the dopaminergic system may play a major role in the pathophysiology of depression. Preclinical studies suggest synergistic antidepressant effects with the combination of a SSRI and a selective D3 receptor agonist in animal models of depression. Similarly, preliminary clinical studies suggest synergism with combination treatment that affects the serotonin and dopamine systems. Together, these data suggest that treatments which affect the serotonin and dopamine systems will be more effective than agents which use a single mechanism. We are currently comparing the combination of a selective dopaminergic agonist and a SSRI in patients with treatment-resistant major depression. This study is still ongoing and actively recruiting subjects. The study results are not yet available as the study has not been completed. To our knowledge, this is the only controlled double-blind study to date that is examining the efficacy of a serotonin and dopamine combination given from the start of treatment. Patients, ages 18 years or older, with a diagnosis of major depression are being randomized to the combination of a selective dopaminergic receptor agonist and a SSRI or either drug alone for a period of 6 weeks.