【作者】 时杰；

【机构】 北京大学中国药物依赖性研究所； 中国毒品滥用防治专家委员会； 中国毒理学会药物依赖性专业委员会； 药物依赖性研究北京市重点实验室； 国家食品药品监督管理总局； 国家财政部投资评审中心；

【摘要】 随着现代社会人们生活节奏的加快,社会心理压力的增加,失眠的发生率呈逐年上升趋势。由于失眠治疗的慢性化特点,患者常常会长期使用催眠药物,并带来一系列成瘾性的问题。治疗失眠的药物种类繁多,根据其不同的作用特点可以分为巴比妥类、苯二氮?类药物、非苯二氮?类药物、抗抑郁药物、抗组胺药物、褪黑素受体激动剂以及近期美国FDA批准上市的食欲素受体拮抗剂等。传统的巴比妥类药物因其较强的成瘾性问题和不良反应已经较少用于治疗失眠。因苯二氮?类药物也具有一定的成瘾性,在某些特定情况下,非苯二氮?类药物被逐渐纳入考虑范围中。以往的观点认为非苯二氮?类药物的成瘾性较小和耐受性较好,但是,近年来的临床研究发现非苯二氮?类药物,如唑吡坦、佐匹克隆等也具有一定的成瘾性问题。一些新型的催眠药物,如食欲素受体拮抗剂也因其潜在成瘾性问题而被纳入Ⅳ类管制药品。近期的一些研究发现,苯二氮?类药物的成瘾性机制可能是通过结合腹侧被盖区(VTA)特定的GABAA受体来减少中间神经元的抑制作用,从而增加多巴胺能神经元的兴奋性。催眠药物的长期使用会对机体产生许多不利影响,能够增加痴呆、死亡和肿瘤发生的风险。除此之外,短期使用催眠药物也会带来一系列不利后果,如造成个体日间功能下降、交通意外和感染等问题。认知行为治疗可以有效改善失眠患者的睡眠质量,联合使用认知行为治疗和药物治疗,对于提高患者的睡眠质量,改善患者的认知和社会功能具有明显的临床效果。更多还原

【Abstract】 As the pace of people’s life is speeding up and their psychological pressures is getting higher, the incidence of insomnia has been increasing over time. Due to the chronic characteristics of insomnia treatment, patients often use hypnotic drugs for a long time, leading to a series of problems, such as addiction. There are many hypnotic drugs for insomnia patients, which can be divided into different types according to its different action characteristics, including barbiturates, benzodiazepines, non-benzodiazepines, antidepressants, antihistamines, melatonin receptor agonists and orexin receptor antagonists that was approved by FDA recently. Because of the strong induced addiction problems and adverse effects, the traditional barbiturates have been abandoned in the treatment of insomnia. As well, non-benzodiazepines have been taken into account in certain circumstances in that benzodiazepines are addictive. Historically, it is believed that non-benzodiazepines are less addictive and its tolerance is better. But in recent years, the clinical study found that non-benzodiazepines are a bit addictive in sometimes, such as zolpidem, zopiclone, etc. Some new hypnotic drugs, for example orexin receptor antagonists are thought to have some addiction potential and is rated Schedule IV. Some recent studies have found that the addictive mechanism of benzodiazepines could be through a combination with specific GABAA receptor in Ventral Tegmental Area(VTA) to decrease inhibition of interneuron, thus increasing the excitability of dopaminergic neurons. A long time use of hypnotic drugs can produce many negative effects on human body, increasing the risk of dementia, death and tumorigenesis. In addition, short-term use of hypnotic drugs may also cause a series of adverse consequences, such as impaired daytime function, traffic accidents, infections and other problems. Cognitive behavioral therapy(CBT) can effectively improve the quality of life for patients with insomnia, and CBT combined with pharmacotherapy is approved with clinical efficacy in improving sleep quality, cognitive and social functions.更多还原