Kennedy S H, Eisfeld B S
Mood Disorders Program, University of Toronto, Ontario, Canada.
Clin Cornerstone. 1999;1(4):1-16. doi: 10.1016/s1098-3597(99)90021-2.
In recent years, clinicians and epidemiologists have examined the differences between depressed patients in primary care and psychiatric settings. Although evidence to support antidepressant efficacy is largely derived from studies of major depression, many patients in primary care settings fall into "nonmajor" depression diagnostic categories. In deciding when to initiate treatment, functional change may be even more important than discrete symptom profiles. Recognizing and treating depression as a comorbid condition in patients with other medical illnesses represents an additional challenge for the primary care physician. Variations in the clinical presentation of depression based on gender, age, culture, or personality must also be considered.
近年来，临床医生和流行病学家研究了初级保健机构和精神科环境中抑郁症患者之间的差异。虽然支持抗抑郁药疗效的证据主要来自重度抑郁症的研究，但初级保健机构中的许多患者属于“非重度”抑郁症诊断类别。在决定何时开始治疗时，功能变化可能比离散的症状特征更为重要。将抑郁症识别并作为其他内科疾病患者的共病进行治疗，对初级保健医生来说是一项额外的挑战。还必须考虑基于性别、年龄、文化或个性的抑郁症临床表现差异。
