主要作者Lakshmi N. Yatham向Medscape表示，研究結果顯示，[LTG]是唯一對憂鬱性復發有較好療效的用藥。Yatham醫師是精神學科教授也是加拿大溫哥華 英國哥倫比亞大學Michael Smith基金會資深學者，他強調，這對目前所有的用於預防躁鬱症的用藥，其療效在避免狂躁的效果皆優於抑鬱的效果而言，不失為是一個重要的臨床意義。
與安慰劑比較，經LTG治療後，較少的最近狂躁患者其需要做憂鬱症介入處理 (LTG 14%，Li 22%， PBO 30%; P = .034 for LTG vs. PBO)及符合精神疾病診斷及統計學手冊第4版(DSM-IV)，憂鬱症標準(LTG 10%， Li 17%， PBO 28%; P = .024 for LTG vs. PBO)或Hamilton憂鬱等級分數大於20的抑鬱性副作用被報導(LTG 0， Li 4%， PBO 3%)。
Evaluation and Progress of Second-generation Antipsychotic Drugs
[摘要]评价第二代抗精神病药的临床应用与进展。方法：查阅近期国内、外有关文献，进行分析、归纳。结果：抗精神病药的合成进展迅速，第二代抗精神病药在整体上能改善精神病者的认知功能，安全性和耐受性好，成为治疗精神分裂症和精神病有效的首选药物。
[关键词]精神病；精神分裂症；抗精神病药；进展，评价
[ABSTRACT]OBJECTIVE: To evaluate the progress and clinical application of second-generation antipsychotic drugs. METHODS: To review and analyze recent literatures at home and abroad. RESULTS:Advance in synthetise of the second-generation antipsychotic drugs has been swiftly in rencent years,it improve the recognizing ablity of patients with schizophrenia,it has good safety and tolerance,is still the efficient and first choice drug for the treatment of patients with psychotic and schizophrenia.
[KEY WORDS]Psychotic；Schizophrenia；Antipsychotic drugs；Progress；Evaluation
上世纪50年代，抗精神病药取得重大的发展，也形成药理学的一个分支(精神药理学)，抗精神病药的合成连接不断，研制和上市的品种不下百个。其中第一代抗精神病药(氯丙嗪、氟奋乃静、氟哌啶醇、氟哌噻吨、奋乃静和甲硫哒嗪等)的作用机制为阻断边缘系统和纹状体的多巴胺D2受体(D2 Receptor)，成为抗精神病药作用基础，但纹状体多巴胺功能的减弱可导致锥体外系综合征(EPS)，包括迟发性运动障碍，下丘脑-垂体轴D2受体阻断可致高泌乳素血症。随着时间的推移，第一代抗精神病药大都完成治疗使命，斗转星移，第二代抗精神病药成为当前的一线用药。
1第二代抗精神病药的进展与作用特点
第二代抗精神病药统称非典型抗精神病药，其发展见于近20年，与第一代相比，其在药理学上特点有有：(1)与D2受体的亲和力相对较低，而与其他神经受体的亲和力相对较高。决定非典型抗精神病药作用的药理学特征是阻断D2/5-羟色胺2α亚型(5-HT2α)受体比例的大小，低比例是其特征；(2)此外，第二代的作用还具有一定程度的解剖学区域性，能改变边缘系统和额叶皮质的神经化学活动，而对纹状体的作用非常小。迄今为止，所有有效的抗精神病药都与D2受体有一定程度的亲和力，尚未发现与D2受体无亲和力的抗精神病药；(3)第二代的化学结构具多样性，其疗效与药理学特征有关。近期研究表明，第二代药在产生临床疗效与发生EPS之间具有较大剂量空间。奥氮平、喹硫平与氯氮平作用类似；利培酮、舍吲哚、齐拉西酮与氯氮平作用有所不同；而氨磺必利既不同于其他第二代药，也不同于第一代药。因此，第二代药可能具有不同的作用机制[1～2]。(4)第二代抗精神病药的安全性好，且产生EPS的危险性较小，极少有导致迟发性运动障碍的倾向(甚至对先前存在的迟发性运动障碍有所帮助)，其耐受性总体上也较第一代好。可作为治疗精神分裂症的一线药，且在患者初次发病时首选。
(5)研究显示，第二代药在整体上能改善认知功能，但目前尚不清楚此疗效是直接的治疗效果，还是由于其避免诱发急性EPS或改善第一代药恶化认知功能的结果？第二代药可能改善情感症状，尤其是抑郁症状。由于精神分裂症者的抑郁和自杀发生率较高，此项作用显得很重要。
第二代药具有较少的镇静作用且较少抑制精神运动性行为，但治疗急性起病、有攻击性的患者疗效欠佳，则为其缺点[3]。
表1.第二代抗精神病药的上市概况
Tab1.The general situation of the second-generation antipsychotic drugs
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医学探索：加拿大发现治疗躁狂抑郁症新药
NOP World Health隶属全球研究公司十强之一的NOP World公司旗下，聚焦于健康领域的调研。NOP World Health的研究显示，Symbyax中2个有效成分的协同效应以及良好的有效性，是促使本品成功的关键性优势。同样，研究者也尖锐的指出了本品存在的几方面不足，譬如：复方制剂的使用、体重增加等不良反应，以及存在使患者从抑郁状态调转为躁狂状态的风险。
Glutamate and g-aminobutyric acid system in mood disorder
ZHOU Xuan1; WANG Xue-qi2
(1. Psychiatry and Health Subject 2000 Grade, 2.Dpartment of Neurobiology, Second Military Medical University, Shanghai 200433, China)
[Abstract] There is increasing evidence that glutamate and γ-aminobutyric acid (GABA) systems may contribute to mood disorder. For example, antidepressant drugs may reduce N-methyl-D-aspartate （NMDA）receptor function directly or indirectly; NMDA receptor antagonists may be antidepressant. Drugs that reduce glutamatergic activity or glutamate receptor-related signal transduction may also have antimanic effects. Recent studies employing magnetic resonance spectroscopy (MRS) also suggest that unipolar depression is associated with reduction in cortical GABA levels; Antidepressant and mood-stabilizing treatments also appear to raise cortical GABA levels and to ameliorate GABA deficits in patients with mood disorders. Future research will be needed to develop and evaluate new agents with specific glutamate and GABA receptor targets in the treatment of mood disorders.
NMDA受体拮抗剂对人的影响的最初证据主要来源于DCS（D-cycloserine）。治疗剂量（500 mg/d）的DCS可产生相当快速并与剂量相关的欣快感和记忆减退（euphoric and amnestic effects），这与非竞争性NMDA受体拮抗剂所产生的作用类似[7]。因此，DCS的抗抑郁效应可能与其降低NMDA受体功能相关。
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我的医生说他怕病人容易乱想就很少回答问题，因为每个人的情况不同他们也学了很久很深所以回答肯定不全面容易产生误解，所以他从来不回答病人的有关专业的问题。不过他会交代比较理智的家属的相关常识。何况好的医生病人太多时间来不及。所以不要乱想，要信任医生。作者: cocofu 时间: 05-3-20 12:46
你误会了，我不是在做广告，我是在义务收集公布资料而已作者: cocofu 时间: 05-5-4 17:07
甲磺酸瑞波西汀Reboxetine mesilate(Edronax)
本品是瑞典/美国Pharmacia & Upjohn 公司开发的抗抑郁新药，是第一个应用于临床的高选择性和强效去甲肾上腺素重摄取抑制剂（NaRI），97年在英国首次上市，至今已在50多个国家上市。重庆医药工业研究院,中国科学院成都有机化学研究所于2002年10月28日取得了甲磺酸瑞波西汀及胶囊的新药批件.2002年9月22日国家药品监督管理局发布了二类新药甲磺酸瑞波西汀原料及胶囊的临床公告.
“激越，无论对于发生这种状况的病人来说还是对于他们的护理者来说，都是一个重要的问题。激越是痴呆症的一个表现，即难以控制，同时对于那些护理痴呆病人的人来说也会造成情绪上的困扰，” Pierre Tariot 医生这样说道，他是罗彻斯特大学的精神病学、医学和神经病学教授。“这些新的临床研究结果提供了有意义的信息，并且提示进一步研究使用“思瑞康”治疗痴呆病人的激越症状是合理的。”