TIME:抗抑郁药可能会改变人的性格
一项健康研究表明,选择性5-羟色胺再摄取抑制剂(SSRI类药物)能够有效缓解抑郁症状——尽管新的调查认为,由于被调查人仅限于患有严重抑郁症的人群,可能会导致这一发现存在偏差,而且抗抑郁药仅仅在重度抑郁症患者身上取得的效果比安慰剂的效果要明显的多。西北大学的一项研究也许能为我们揭示,抗抑郁药是如何影响人的性格的——以及这种影响能否成为他们成功克服抑郁的关键。在一项包含240位抑郁症患者的安慰剂对照研究中,心理学家Tony Tang和他的同事们发现,与服用安慰剂的参与者相比,服用抗抑郁药的参与者们不仅减轻了抑郁症状,而且在性格方面也有较大的改变——特别是没有以前那么神经质,变得更加外向了。
在《Archives of General Psychiatry》十二月刊中发表的一项研究认为,抗抑郁药的功效也许是通过改变患者特有的消极个性特质来实现的。之前的研究显示,高度的神经质可能带来抑郁的风险,同时,其他的研究也发现,与抑郁和严重神经质相关联的基因在很大程度上有重叠。此外,早期的调查显示,神经质和外向性格都与大脑的5-羟色胺处理系统相关,这也是抗抑郁药主要的治疗靶点。
在最近的一次随机研究中,120名参与者被随机安排服用抗抑郁药帕罗西汀(paroxetine,赛乐特),与大多数的抗抑郁药试验结果相似,研究者们发现与服用安慰剂的参与者相比,服用抗抑郁药的参与者在抑郁症状的改善方面比较明显。然而,当研究者开始分析SSRI药物是如何影响性格时,他们发现该组参与者在神经过敏症状有了很大的减缓,变得比较外向。而此现象在服用安慰剂的对照组中并未出现。与服用安慰剂的对照组相比,服用帕罗西汀的参与者在神经过敏症状的变化是前者的6.8倍,而在外向性的变化上则是前者的3.5倍。
该报告的作者希望该此项最新研究可以为应用SSRI类药物帮助病人战胜抑郁症的进一步深入研究铺平道路。
【希波克拉底王的评述】
之所以对这篇文章感兴趣,是因为该文发现了SSRI类抗抑郁药物治疗抑郁症的新途径。我曾经在博客中讲过早泄的药物治疗(说时迟那时快——浅谈早泄 ),其中一线用药即是SSRI类抗抑郁药,但目前尚不清楚SSRI类药治疗早泄的真正机制。其实,对于早泄的发病原因,大家的争论也很大,也不是很清楚,有的讲是由于阴茎局部神经过于敏感,也有人认为是大脑内的五羟色胺浓度过低,但这些都还存在很多疑虑。
既然SSRI类药物通过改变人的神经质症状和内向性格来治疗抑郁症,那么我们为什么不能想到早泄可能与神经质和内向性格有关呢?在临床上,我们的确发现很多早泄病人存在神经质和内向性格问题,SSRI类药物是否可以通过纠正性格异常来达到治疗早泄的奇效呢?这些问题值得我们进一步探讨和研究。
Antidepressants may alter personality
Clarification added January 6, 2010.
A wealth of research has shown that selective serotonin reuptake inhibitors (SSRI) are effective at reducing the symptoms of depression—though new research suggests that study populations limited to those with severe depression may skew these findings, and that antidepressants only show truly significant benefits over placebo in patients with major depressive disorder.* A new study out of Northwestern University may shed some new light on how these antidepressants impact personality—and whether that influence may in fact be key to their success in combating depression. In a placebo-controlled study of 240 adults with major depressive disorder, psychologist Tony Tang and colleagues found that, not only did participants taking the medication show improved reduction in depression symptoms compared with those taking the placebo, but that they also showed marked differences in personality—exhibiting less neuroticism and more extroversion, in particular.
The findings, published in the December issue of the Archives of General Psychiatry, suggest that the mechanism through which antidepressants function may be by altering personality traits that often characterize depression. Previous study has shown that high levels of neuroticism can indicate a risk for depression, while other research has found a substantial overlap in the genes associated with both depression and severe neuroticism. Additionally, earlier investigations have shown that both neuroticism and extroversion are associated with the brain's serotonin processing systems, which are targeted by SSRI antidepressants.
In this most recent study, 120 participants were randomly assigned to take the antidepressant paroxetine (Paxil and Seroxat), and, as in most trials of antidepressants, researchers found that they exhibited slightly greater improvement in depression symptoms compared with participants taking the placebo. Yet, when researchers analyzed how the SSRI impacted personality, they found that people in the trial group showed a dramatic decrease in neuroticism and increase in extroversion not seen in the control group. Compared with the placebo group, on average, participants who took paroxetine had a 6.8-fold change in signs of neuroticism, and 3.5 times as much change in signs of extroversion.
The study authors are hopeful that this latest research might pave the way for continued research into the mechanism through which SSRIs help patients battle depression.
*This was added in light of a study released on January 5, 2010 by the Journal of the American Medical Association finding little benefit of antidepressants to patients with mild and moderate depression.
Read more: http://wellness.blogs.time.com/2010/01/04/antidepressants-may-alter-personality/#ixzz0e5aHdi4l


