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首页> 外文期刊>The journal of clinical psychiatry >Combining stimulants with monoamine oxidase inhibitors: a review of uses and one possible additional indication.
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Combining stimulants with monoamine oxidase inhibitors: a review of uses and one possible additional indication.

机译：兴奋剂与单胺氧化酶抑制剂的组合：用途回顾和一个可能的附加适应症。

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BACKGROUND: Among antidepressant augmentation strategies, the addition of a stimulant to a monoamine oxidase inhibitor (MAOI) has received little attention in the literature in recent years because of the diminished clinical use of the latter and concerns of precipitating a hypertensive crisis or other serious complication. Despite that fact, experienced clinicians continue to use this combination for a variety of indications after other options have failed. This article reviews these reported uses and presents a case suggesting another possible indication. METHOD: A MEDLINE search was conducted for articles published from 1962 to December 2003 using relevant search terms (psychostimulant, stimulant, amphetamine, dextroamphetamine, pemoline or methylphenidate, atomoxetine, bupropion, monoamine oxidase inhibitor, and selegiline). A manual search was conducted of cross-references and other relevant recent psychiatric sources (2000-2003). RESULTS: The described uses of the MAOI-stimulant combination have included treatment of refractory depression and the MAOI-related side effects of orthostatic hypotension and daytime sedation. No documented reports were found in the recent literature of hypertensive crises or fatalities occurring when the stimulant was cautiously added to the MAOI. Also presented here is another possible indication for this therapeutic regimen: treatment of attention-deficit/hyperactivity disorder in an adult patient whose major depression had uniquely responded to the MAOI tranylcypromine. CONCLUSION: As in other fields of medicine, potentially hazardous medication combinations are utilized in psychiatry after cautiously weighing the danger of the treatment against the morbidity and risk of not adequately addressing the illness. Particularly, as the potential arrival of the apparently safer transdermal selegiline may increase the use of MAOIs, we feel this combination deserves additional controlled study.
机译：背景：在抗抑郁药的增强策略中，由于单胺氧化酶抑制剂（MAOI）在临床上的使用减少以及对高血压病或其他严重并发症的担忧，近年来在单胺氧化酶抑制剂（MAOI）中添加刺激剂的研究很少。 。尽管如此，在其他选择失败后，经验丰富的临床医生仍会继续使用此组合进行各种适应症。本文回顾了这些报告的用途，并提出了一个案例，提出了另一种可能的指示。方法：使用相关搜索词（心理刺激剂，兴奋剂，苯丙胺，右旋苯丙胺，匹莫林或哌醋甲酯，阿莫西汀，安非他酮，单胺氧化酶抑制剂和司来吉兰）对1962年至2003年12月发表的文章进行MEDLINE搜索。手动搜索了交叉参考和其他相关的近期精神病学资料（2000-2003年）。结果：MAOI-兴奋剂联合使用的描述用途包括难治性抑郁症的治疗以及体位性低血压和白天镇静的MAOI相关副作用。在最近的文献中未发现将兴奋剂谨慎添加到MAOI中时发生的高血压危机或死亡的报道。本文还介绍了该治疗方案的另一种可能的适应症：在成年患者中注意缺陷/多动障碍的治疗，该患者的主要抑郁症对MAOI tranylcypromine有独特的反应。结论：与其他医学领域一样，在谨慎权衡治疗的危险性和发病率以及未充分解决疾病风险之后，在精神病学领域中使用了具有潜在危险性的药物组合。特别是，由于似乎更安全的透皮司来吉兰的潜在到来可能会增加MAOI的使用，因此我们认为这种组合值得进一步的对照研究。

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