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首页> 外文期刊>The Australian and New Zealand journal of psychiatry >Why do stimulants not work in typical depression?
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Why do stimulants not work in typical depression?

机译：为什么兴奋剂在典型的抑郁症中不起作用？

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Stimulants have been suggested as therapeutics in depression for 80years now, but there is still no evidence from randomized controlled trials that stimulants, in general, possess specific antidepressant effects. Also, several recent large randomized controlled trials which tried to establish an indication for stimulants as add-on in depression failed, and the companies no longer proceed with regulatory filings. One reason why the common belief of an antidepressant effect has survived over decades is a lack of clarity in psychopathology. Tiredness in the sense of sleepiness (downregulation of arousal) and lack of drive are mixed up with tiredness in the sense of exhaustion with high inner tension (upregulation of arousal) and inhibition of drive. The latter is found in typical depression, and according to the recently introduced arousal regulation model of affective disorders, upregulation of arousal is considered to be an important pathogenetic factor. Psychostimulants are unlikely to have beneficial effects in those patients with upregulated arousal. However, there might be subgroups of depressed patients, such as atypical depression, which suffer from sleepiness and lack of drive and might respond to stimulants. Arousal, a dimension included in the Research Domain Criteria project of the National Institute of Mental Health, can be assessed with an electroencephalography-based algorithm (the Vigilance Algorithm Leipzig) and is a promising biomarker to identify subgroups of patients, which might respond to stimulants.
机译：兴奋剂已经提出为抑郁症的治疗剂，但现在仍然没有来自随机对照试验的证据，这通常具有特异性抗抑郁作用。此外，几个最近的大型随机对照试验，该试验试图为抑郁症的附加加载而建立兴奋剂的指示，而且公司不再继续进行监管申请。几十年来避免抗抑郁效应的常见信念的一个原因是精神病理学缺乏清晰度。困倦的困倦（唤醒的下调）和缺乏驱动器的疲劳与疲劳感，具有高内部张力（唤醒的上调）和抑制驱动器。后者被发现在典型的抑制中，并且根据最近引入的情感障碍的唤醒调节模型，唤醒的上调被认为是一个重要的致病因子。精神疗法不太可能在那些上调唤醒患者中具有有益的效果。然而，可能存在抑郁症患者的亚组，例如非典型抑郁症，其患有嗜睡和缺乏驱动，并且可能对兴奋剂作出反应。唤醒，可以通过基于脑电图的算法（警戒算法Leipzig）评估研究所的研究领域标准项目中包含的维度，并且是一个有前途的生物标志物，用于鉴定患者的亚组，这可能会响应兴奋剂。

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