Berber M J
Markham Stouffville Hospital, Ontario.
Can Fam Physician. 1999 Nov;45:2663-8.
To review the pharmacological treatment of depression and to evaluate current strategies for treatment to maximize the benefits of antidepressant medications.
MEDLINE was searched to January 1999, using the headings depression, combination, augmentation, lithium, triiodothyronine, pindolol, buspirone, methylphenidate, and electroconvulsive therapy, for randomized controlled trials, systematic overviews, and consensus reports. Recent high-quality reviews were often found. References from papers retrieved were scrutinized for other relevant reports. Preference was given to more recent articles and well-designed studies. Recommendations from academic groups were analyzed.
Optimization of antidepressant therapy is the cornerstone of pharmacological treatment of depression. When symptoms persist despite optimization, further strategies include substitution, combination, augmentation, and reviewing and sometimes referring. Decisions are based on the evidence supporting the various strategies.
Antidepressants will work only if prescribed correctly. Awareness of the strategies for using antidepressants and evaluating their effectiveness improves primary care physicians' ability to treat this common disorder.
回顾抑郁症的药物治疗，并评估当前的治疗策略，以最大化抗抑郁药物的益处。
检索MEDLINE至1999年1月，使用“抑郁症”“联合用药”“增效”“锂盐”“三碘甲状腺原氨酸”“吲哚洛尔”“丁螺环酮”“哌甲酯”和“电惊厥治疗”等主题词，查找随机对照试验、系统综述和共识报告。经常能找到近期的高质量综述。对检索到的论文参考文献进行仔细审查，以查找其他相关报告。优先选择近期文章和设计良好的研究。分析学术团体的建议。
优化抗抑郁治疗是抑郁症药物治疗的基石。当优化治疗后症状仍持续时，进一步的策略包括换药、联合用药、增效，以及复查，有时还需转诊。决策基于支持各种策略的证据。
抗抑郁药只有正确处方才能起效。了解使用抗抑郁药的策略并评估其疗效，可提高初级保健医生治疗这种常见疾病的能力。
