Spadone C
Hôpital Foch, 40, rue Worth, BP 36, 92151 Suresnes cedex, France.
Encephale. 2002 May-Jun;28(3 Pt 1):255-9.
It is difficult to achieve treatment compliance in recurrent depressive disorders. This disease involves a combination of psychiatric and depressive disorders and is a chronic condition: all of the characteristic features of the disease constitute an obstacle to compliance. Compliance in depressive patients may be improved through various approaches. Information provided to patients, which is widely encouraged today both by doctors and by the regulatory authorities, must be as complete as possible; it must include discussion of factors of that favor depression, as well as the logical basis of the management approach proposed. Furthermore, the best guarantee of compliance is probably maintenance of euthymia by means of suitable treatment. Long-term therapy with antidepressants and the institution of a mood regulator (valproate in particular) have both been shown to be efficacious and significantly superior to placebo. Published studies show that continued treatment with an antidepressant can reduce the risk of depressive relapse noted during long-term follow-up (between 18 months and 5 years) by at least 50%. This has been demonstrated for both tricyclic antidepressants and specific serotonin reuptake inhibitors. The need for continued long-term administration of the dosages with proven efficacy during the acute episode has been demonstrated for imipramine but also appears to have been verified for SSRIs. Even when depressive relapse occurs, it is often less severe if the antidepressant treatment has been continued. Although first-line preventive therapy generally comprises long-term continued administration of the antidepressant, use of mood regulators may occasionally be proposed: valproic acid is generally preferred over lithium assaults on the ground of safety. However, there are few studies demonstrating the preventive efficacy of structured psychotherapy against recurrence of depression. Good treatment compliance entails major benefits: the prescribed treatment is able to reduce the risk of recurrence of depression, and in all probability also reduces subsequent vulnerability to depression, even after treatment discontinuation, as emphasized by the kindling theory of R. Post.
复发性抑郁症患者很难做到坚持治疗。这种疾病涉及精神疾病和抑郁症的综合症状，是一种慢性病：该疾病的所有特征都构成了坚持治疗的障碍。抑郁症患者的治疗依从性可通过多种方法得到改善。如今，医生和监管机构都广泛鼓励向患者提供尽可能全面的信息；这些信息必须包括对引发抑郁症因素的讨论，以及所提议治疗方法的逻辑依据。此外，坚持治疗的最佳保障可能是通过适当治疗维持心境正常。抗抑郁药的长期治疗以及使用情绪稳定剂（特别是丙戊酸盐）均已证明有效，且显著优于安慰剂。已发表的研究表明，长期服用抗抑郁药可将长期随访（18个月至5年）期间抑郁症复发的风险降低至少50%。这已在三环类抗抑郁药和选择性5-羟色胺再摄取抑制剂中得到证实。丙咪嗪已证明在急性发作期间需要持续长期服用已证实有效的剂量，对于选择性5-羟色胺再摄取抑制剂似乎也已得到验证。即使抑郁症复发，如果持续进行抗抑郁药治疗，病情通常也会较轻。虽然一线预防性治疗通常包括长期持续服用抗抑郁药，但偶尔也可能会提议使用情绪稳定剂：基于安全性考虑，丙戊酸通常比锂盐更受青睐。然而，很少有研究证明结构化心理治疗对预防抑郁症复发的疗效。良好的治疗依从性会带来重大益处：规定的治疗能够降低抑郁症复发的风险，而且很可能还会降低后续患抑郁症的易感性，即使在停药后也是如此，正如R. Post的点燃理论所强调的那样。
