Imipramine Hydrochloride

近日，歌手李玟的姐姐李思林发文称李玟因抑郁症轻生去世，终年48岁。一代音乐巨星的陨落令人深感惋惜，同时也再一次将“抑郁症”——这一正在成为仅次于癌症的人类第二大“杀手”，带到了大众视野面前。抑郁症简介抑郁症是一种常见的心理健康问题，也被称为抑郁性障碍。它不仅会影响一个人的情绪，还会对日常生活、工作和人际关系产生负面影响。据世界卫生组织官网显示：全球估计有3.8%的人口患有抑郁症，其中包括5%的成年人（男性为4%，女性为6%），以及5.7%的60岁以上的成年人。世界上大约有2.8亿人患有抑郁症。主要症状及其分类抑郁症的主要症状表现为持续的、沮丧的情绪和对兴趣和快乐感的丧失。其他常见症状包括失眠或过度睡眠、食欲改变、体重变化、疲劳感、注意力和集中力减退、自责和无价值感、决策困难、消极思维、自杀念头或行为等。抑郁症可以根据不同的维度进行分类，根据临床表现，抑郁症可分为1.单次发作抑郁症：指患者经历了一次或多次抑郁发作，每次发作之间都有明显的间隔期。2.反复发作抑郁症（又称为复发性抑郁症）：指患者经历了多次抑郁发作，每次发作之间可能有较短的间隔期或无间隔。3.持续性抑郁症（又称为慢性抑郁症）：指患者至少连续两年持续存在抑郁症状，没有明显的间隔期。4.双相情感障碍（又称为躁郁症）：除了抑郁发作外，患者还经历了躁狂发作或躁狂状态。5.其他特殊类型的抑郁症，如季节性抑郁症（SAD）和产后抑郁症等。根据症状严重程度分类，抑郁症又可分为1.轻度抑郁症：症状轻微，对日常功能影响较小。2.中度抑郁症：症状中等程度，对日常功能有一定影响。3.重度抑郁症：症状严重，明显影响日常功能，可能出现自杀念头或行为。发病机制抑郁症的发病原因是复杂的，通常是由遗传、生物学、心理社会和环境因素相互作用而产生的。家族史、生物化学的改变（如神经递质不平衡）、心理创伤、慢性压力、孤独、社会支持缺乏等都可能增加抑郁症的风险。抑郁症的发病机制目前尚未完全明确，但是有一种比较公认的假说是单胺假说，它认为中枢神经系统突触间隙单胺类神经递质浓度水平或功能下降是抑郁症的生物学基础。抑郁障碍的神经生化机制主要涉及5-羟色胺(5-HT)、 去甲肾上腺素 (NE)和 多巴胺 (DA)三个主要的神经递质，且这三个单胺能神经递质系统协同发挥作用。图1：抑郁症的单胺假说治疗手段抑郁症治疗方法多样，包括心理治疗、药物治疗和其他治疗方法。个体化的治疗计划可以根据患者的情况和病情严重程度进行制定。其中，药物治疗在抑郁症管理中发挥着重要作用。治疗抑郁症的药物通常可以分为以下几类：1.选择性5-羟色胺再摄取抑制剂（SSRIs）：这是最常用的抗抑郁药物类别之一，包括药物如氟西汀（Fluoxetine）、舍曲林（Sertraline）、帕罗西汀（Paroxetine）等。它们通过抑制大脑中5-羟色胺的再摄取，增加5-羟色胺水平，帮助改善抑郁症状。2.选择性去甲肾上腺素再摄取抑制剂（SNRIs）：这类药物抑制去甲肾上腺素和5-羟色胺的再摄取，如文拉法辛（Venlafaxine）和达腊西汀（Duloxetine）。它们与SSRIs类似，但同时对去甲肾上腺素也起作用。3.三环抗抑郁药（TCAs）：如阿米替林（Amitriptyline）和丙米嗪（Imipramine）。它们通过调节多种神经递质（包括5-羟色胺和去甲肾上腺素）的水平，帮助缓解抑郁症状。4.喹硫平类药物：如舒必利（Mirtazapine）。它们通过增加去甲肾上腺素和5-羟色胺的释放来缓解抑郁症状，同时还对一些神经递质受体起作用。5.单胺氧化酶抑制剂（MAOIs）：如苯乙肼（Phenelzine）和丙脒隆（Tranylcypromine）。它们通过抑制单胺氧化酶的活性，增加多巴胺、去甲肾上腺素和5-羟色胺的水平。此外，还有其他一些药物，如腺苷再摄取抑制剂（例如氟哌啶醇）、非典型抗精神病药物（如奥氮平）和抗焦虑药物（如苯二氮䓬类药物），在某些情况下也可以用于治疗抑郁症。药物市场现状及展望在这里，我们根据中国医药工业信息中心PDB药物综合数据库和CPM新药研发监测数据库汇总了2023年Q1季度样本医院销量TOP10的药物以及它们各自对应的靶点。可以看到在销量排名前10的药物中，大部分抗抑郁药的作用机制都是5-羟色胺再摄取抑制剂（SSRIs）。然而抑郁症的发病机制十分复杂，并不是所有的抑郁症患者都对SSRI类疗法有响应，研究表明，抑郁症的病理机制还可能与大脑皮层和边缘系统内部的神经回路有关。这些回路中的神经元主要释放谷氨酸（Glu）和γ-氨基丁酸（GABA）这两种神经递质。谷氨酸递质的受体系统可以分为两个主要类型：(1)离子型受体（ionotropic receptors），包括NMDA受体（NMDAR）、AMPA受体（AMPAR）和红藻氨酸受体（kainate receptor）；(2)代谢型受体（metabotropic receptors，mGluRs）。可以看到销量排名第四的艾司氯胺酮就属于NMDA受体拮抗剂的代表之一。此外以阿戈美拉汀为代表的褪黑素类抗抑郁药，是MT1和MT2受体的激动剂。不仅能明显改善抑郁症状，而且针对性的治疗抑郁所致失眠症状，是抑郁性失眠的最佳治疗药物。表1：2023年Q1样本医院销量T0P10的抗抑郁药  来源：PDB药物综合数据库&CPM新药研发监测数据库中国医药工业信息中心尽管目前来看Q1季度销量前10的药物均为西药，但中药在治疗抑郁症方面的潜力同样不容小觑。根据中国医药工业信息中心Pharma ONE智能药物大数据分析平台统计，目前总共已有9款中药获批上市用于治疗抑郁症。就在上个月，国家药品监督管理局批准了广东思济药业有限公司申报的中药1.1类创新药参郁宁神片上市，是今年来第一款获批的中药新药。该药品益气养阴，宁神解郁。适用于轻、中度抑郁症中医辨证属气阴两虚证，参郁宁神片由西洋参、郁金、酸枣仁（炒）、五味子四种中药药材制成，临床试验研究结果显示可用于益气养阴，宁神解郁，适用于轻、中度抑郁症中医辨证属气阴两虚证。参郁宁神片的上市不仅增强了我国中药新药研发的信心，同时也为抑郁症患者提供了一种新的治疗选择。表2：目前已获批上市的抗抑郁中药（截至20230707）  来源：Pharma ONE智能药物大数据分析平台中国医药工业信息中心曾几何时，抑郁症在很多人眼里只是简单的情绪问题，抑郁症患者往往被轻描淡写的一句“想开点就好了”草草应付。近年来，随着医疗技术的进步和医药相关知识的普及，越来越多的人意识到抑郁症是一种精神障碍，可以通过适当的支持和治疗得到缓解。越来越多抗抑郁药的获批上市也让我们对抑郁症患者的治愈之路充满了信心！年度发布2023年《全球药研新动态》《中国医院市场用药格局》（2023版）2023年《数图药讯》权威发布2021年度中国医药工业百强榜单解读中国仿制药发展报告（2022版）医药行业专项报告中国医药中间体和原料药行业调研报告中国非甾体抗炎类原料药市场调研报告中国祛痰类原料药市场调研报告中国钙拮抗剂类原料药市场调研报告中国血管紧张素Ⅱ受体拮抗剂类原料药市场调研报告中国口服血糖调节类原料药市场调研报告中国中枢兴奋类原料药市场调研报告中国抗痛风类原料药市场调研报告中国脑血管病类原料药市场调研报告END如需获取更多数据洞察信息或公众号内容合作，请联系医药地理小助手微信号：pharmadl001

FRIDAY, March 24, 2023 -- Endless worry, irritability and insomnia are all symptoms of a possible anxiety disorder . Luckily, there are numerous anxiety medications that can help ease the condition. Joy Alonzo , a specialist in the pharmacotherapy of mental disorders at Texas A&M's College of Pharmacy, said recently, “If you understand the different types of medication, then you can become a better advocate for your anxiety treatment. Anxiety is one of the most under-treated mental illnesses, and we need to talk more about it.” So, what medications can bring relief from crippling anxiety? According to the Anxiety & Depression Association of America (ADAA), the most common classes of drugs for the treatment of anxiety include: Selective serotonin reuptake inhibitors (SSRIs) Serotonin-norepinephrine reuptake inhibitors (SNRIs) Benzodiazepines Tricyclic antidepressants Here is a rundown on medications for anxiety. Selective serotonin reuptake i nhibitors (SSRIs) SSRIs work by preventing the body from reabsorbing serotonin, which leaves more available for use. The ADAA describes serotonin as a neurotransmitter that plays a role in feelings of well-being and happiness. SSRIs are considered the first-line treatment for all types of anxiety disorders. A higher dose may be required when treating obsessive-compulsive disorder (OCD). Common side effects : Insomnia Sleepiness Sexual dysfunction Weight gain Dry mouth Common SSRIs: Citalopram ( Celexa ) Escitalopram ( Lexapro ) Fluoxetine ( Prozac , Sarafem ) Paroxetine ( Paxil , Paxil CR , Pexeva , Brisdelle ) Sertraline ( Zoloft ) What else you should know about SSRIs: SSRIs may make it easier to engage in psychotherapy and other wellness activities They may help improve other symptoms of anxiety, including headaches and sleep disturbances Initial side effects typically disappear after four to eight weeks SSRIs are safe for long-term use Check with your provider before stopping their use or changing your dose Serotonin-norepinephrine reuptake inhibitors (SNRIs) This class of medication is also a first-line treatment for anxiety disorders, except for OCD. It works by inhibiting the brain cells' reabsorption of both serotonin and norepinephrine. Serotonin is the neurotransmitter that helps with a sense of well-being. According to Anxiety.org , norepinephrine is considered important for its role in the body’s stress response. Common side effects: Anxiety.org states that SNRIs may have more side effects because they affect serotonin and norepinephrine. These side effects may include: Dry mouth Nausea Nervousness Insomnia Drowsiness Dizziness Headache Sexual dysfunction Loss of appetite Agitation Common SNRIs: Venlafaxine (Effexor) Desvenlafaxine ( Pristiq ) Duloxetine ( Cymbalta ) What else you should know about SNRIs Anxiety.org reports that these medications promote neuroplasticity in the brain. This may make your brain more flexible. There is evidence that these medications work best in combination with psychotherapy. But there is one important caveat. “SSRIs and SNRIs are not an instant fix for symptoms associated with an anxiety disorder, nor do they even provide immediate relief,” Alonzo said. “They work by interacting with the neurotransmitters and receptors in your brain, which can help regulate mood, sleep and energy levels. It is important for patients to understand that these medications may take four to six weeks for full effect.” Benzodiazepines Benzodiazepines are considered a second-line therapy for the treatment of generalized anxiety disorder. According to the ADAA, they work by strengthening the GABA neurotransmitter. This neurotransmitter plays a primary role in feeling calm, muscle relaxation, reduction in brain activity and sleep. Most common side effects: Drowsiness Confusion Dizziness Depression Impaired coordination Vision problems Common benzodiazepines: Alprazolam ( Xanax ) Lorazepam ( Ativan ) Diazepam ( Valium ) What else you should know about benzodiazepines for the treatment of anxiety: They act quickly, but do not stay in the system for long They are not safe for continuous use, and can be addictive May be initiated with a first-line treatment, and then tapered off Do not operate heavy equipment while taking Do not mix with alcohol Not recommended for people with suicidal or addictive tendencies Tricyclic antidepressants According to the Mayo Clinic , tricyclic antidepressants are among the earliest antidepressants. They are often recommended when newer drugs have not been effective. They are not typically used for social anxiety disorder or OCD. They also work by blocking the reabsorption of serotonin and norepinephrine, but their mechanism of action is different and they typically cause more side effects than newer treatments. Common tricyclic antidepressants: Imipramine (Tofranil) Nortriptyline (Pamelor) Desipramine (Norpramin) Clomipramine (Anafranil) Common side effects: Drowsiness Blurred vision Constipation Dry mouth Drop in blood pressure when going from sitting to standing Urine retention Weight loss/weight gain Excessive sweating Tremor Sexual dysfunction What else you should know about tricyclic antidepressants: You should not stop taking these medications abruptly You may need to have blood work done to determine the correct dose Disorientation can occur in older people at higher doses May cause a rapid or irregular heart rate Can increase seizure activity if prone to seizures When to seek treatment for anxiety The National Institute of Mental Health lists these as common symptoms of anxiety: Feeling restless, wound up or on edge Being easily fatigued Having difficulty concentrating Being irritable Having headaches, muscle aches, stomach aches or unexplained pains Difficulty controlling feelings of worry Having sleep problems, such as difficulty falling or staying asleep The ADAA recommends seeking medication for anxiety when you are having physical symptoms, are unable to do what you want because of how you feel or are unable to make life choices because of fear. It is never too early to start treatment. Anxiety treatment can be more effective when used with therapy. It is essential to keep all your appointments with your provider. Do not stop your medication or change the dose without discussing it with your provider. If the side effects affect your daily activities, inform your provider immediately. If, at any time, you feel as though you may be suicidal, reach out to your provider or go to the nearest emergency room. You can also call or text the national suicide prevention hotline at 988. Posted March 2023