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选择性5-羟色胺再摄取抑制剂(selective serotonin reuptake inhibitors,SSRIs)是广泛应用的新型抗抑郁药,用于治疗各种抑郁症。常用的SSRIs有氟西汀、帕罗西汀、舍曲林、氟伏沙明及西酞普兰。SSRIs有多种类型的不良反应,主要为胃肠道反应、停药反应、性功能障碍及抗利尿激素异常分泌综合征等。SSRIs有可能增加儿童和青少年自杀意念和行为的风险,但目前尚无定论。最新研究表明,孕妇早期服用SSRIs似乎不增加胎儿先天畸形风险,但孕妇晚期服用SSRIs,可致新生儿出现肺动脉高压和停药综合征。一般而言,用含SSRIs的母乳喂养是安全的,因其在乳汁中的含量很低,但长期服用对婴儿发育的影响尚不清楚。对于老年人,SSRIs可增加骨折风险。SSRIs和某些药物联用发生相互作用导致的不良反应如下:单胺氧化酶抑制剂:5-羟色胺综合征;利尿剂:严重低钠血症;抗凝血药:增加出血危险;非甾体抗炎药:增加上消化道出血风险;色氨酸:5-羟色胺综征;阿司咪唑、特非那定:室性心律失常,Q-T间期延长;氟哌啶醇、马普替林:严重锥体外系反应;锂盐:锂血浓度升高,毒性增加。总之,SSRIs的不良反应虽然少于三环类抗抑郁药,但其有自身特有的不良反应。因此,医师临床使用SSRIs应予以注意。
Selective serotonin reuptake inhibitors (SSRIs) are widely used new antidepressants for the treatment of various types of depression. Common SSRIs are fluoxetine, paroxetine, sertraline, fluvoxamine and citalopram. There are many types of SSRIs adverse reactions, mainly gastrointestinal reactions, withdrawal reactions, sexual dysfunction and anti-diuretic hormone secretion syndrome. SSRIs may increase the risk of suicidal ideation and behavior in children and adolescents, but there is no conclusive result yet. Recent studies show that pregnant women early SSRIs do not appear to increase the risk of fetal congenital malformations, but the late pregnant women taking SSRIs, can cause neonatal pulmonary hypertension and withdrawal syndrome. In general, breastfeeding with SSRIs is safe because of its low level in milk, but the effects of long-term use on infant development are unclear. For the elderly, SSRIs increase the risk of fracture. Adverse reactions caused by the combination of SSRIs and certain medications are as follows: Monoamine oxidase inhibitors: Serotonin syndrome; Diuretics: Severe hyponatremia; Anticoagulants: Increased bleeding risk; Non-steroidal anti-inflammatory drugs : Increased risk of upper gastrointestinal bleeding; tryptophan: serotonin syndrome; astemizole, terfenadine: ventricular arrhythmia, QT prolongation; haloperidol, maprotiline: severe extrapyramidal Department of reaction; lithium salt: lithium blood concentration increased, increased toxicity. In summary, SSRIs have fewer adverse reactions than tricyclic antidepressants, but have their own unique side effects. Therefore, clinicians should pay attention to the clinical use of SSRIs.