Gelenberg A J, Chesen C L
Department of Psychiatry, University of Arizona Health Science Center, Tucson 85724-5002, USA.
J Clin Psychiatry. 2000 Oct;61(10):712-21. doi: 10.4088/jcp.v61n1002.
For years, investigators have tried to determine the speed of onset of antidepressant drugs. Claims that particular drugs may produce a faster response in patients than other agents have been made, but such claims have never been confirmed.
The authors reviewed reports from studies of the speed of onset of antidepressant therapies and other studies that revealed information on this topic. We compiled a list of factors that can affect the results of such studies and interpretations of study results. In addition, we reviewed literature concerned with methods of speeding up antidepressant responses.
No antidepressant medication currently available has been shown conclusively to have a more rapid onset of action than any other. However, some methods of augmentation may have the potential to speed responses. Somatic therapies such as electroconvulsive therapy, phototherapy, and therapeutic sleep deprivation may be the fastest options available at this time.
All available antidepressant medications are usually taken for several weeks before future responders will display a significant therapeutic benefit. If a patient does not show at least a 20% improvement within the first 2 to 4 weeks of treatment, the treatment regimen should be altered. For patients who do show early benefits from a medication trial, one can expect additional benefits to accrue over an 8- to 12-week period and to improve overall outcome compared with those slower to respond. Future trials need to address methodological confounds, but a truly "faster antidepressant" will probably require new neuroscience technology.
多年来，研究人员一直试图确定抗抑郁药物的起效速度。有人声称某些药物可能比其他药物在患者身上产生更快的反应，但此类说法从未得到证实。
作者回顾了关于抗抑郁治疗起效速度的研究报告以及其他揭示该主题信息的研究。我们编制了一份可能影响此类研究结果及研究结果解读的因素清单。此外，我们还回顾了有关加快抗抑郁反应方法的文献。
目前尚无确凿证据表明现有的任何一种抗抑郁药物比其他药物起效更快。然而，一些增效方法可能有加快反应的潜力。躯体治疗，如电休克治疗、光疗和治疗性睡眠剥夺，可能是目前最快的选择。
所有现有的抗抑郁药物通常需要服用数周，未来才有反应的患者才会显示出显著的治疗效果。如果患者在治疗的前2至4周内改善未达至少20%，则应更改治疗方案。对于在药物试验中确实早期获益的患者，与反应较慢的患者相比，预计在8至12周内会有更多益处，并改善总体结局。未来的试验需要解决方法学上的混杂因素，但真正“更快的抗抑郁药”可能需要新的神经科学技术。
