Keller M B, Hirschfeld R M A, Demyttenaere K, Baldwin D S
Department of Psychiatry, Brown University Medical School, RI 02906, USA.
Int Clin Psychopharmacol. 2002 Nov;17(6):265-71. doi: 10.1097/00004850-200211000-00001.
Major depressive disorder is a chronic and recurrent illness that is associated with significant morbidity and mortality. Patients frequently experience recurrent depressive episodes that are of longer duration and increased severity and which are less responsive to treatment than the index episode. Despite the highly prevalent nature of the illness, depression is frequently unrecognized and undertreated. Compliance with antidepressant medication is essential to consolidate treatment response and prevent relapse and recurrence. However, compliance with antidepressant medication is poor. Education of the patient and physician regarding the nature of depression and its treatment is essential for improving patient compliance. Although psychological mechanisms are a major factor affecting patient compliance, speed of onset of action and poor tolerability of antidepressant medication also have a considerable influence on patient compliance. The newer antidepressants, such as selective serotonin reuptake inhibitors, nonselective serotonin-norepinephrine reuptake inhibitors, and the selective norepinephrine reuptake inhibitors, are better tolerated than tricyclic antidepressants, possibly resulting in improved compliance and treatment outcome.
重度抑郁症是一种慢性复发性疾病，与显著的发病率和死亡率相关。患者经常经历复发的抑郁发作，这些发作持续时间更长、严重程度增加，并且与首发发作相比对治疗的反应性更低。尽管该疾病具有高度普遍性，但抑郁症常常未被识别且治疗不足。坚持服用抗抑郁药物对于巩固治疗效果以及预防复发至关重要。然而，抗抑郁药物的依从性很差。对患者和医生进行关于抑郁症的性质及其治疗的教育对于提高患者依从性至关重要。尽管心理机制是影响患者依从性的主要因素，但抗抑郁药物的起效速度和耐受性差也对患者依从性有相当大的影响。新型抗抑郁药，如选择性5-羟色胺再摄取抑制剂、非选择性5-羟色胺-去甲肾上腺素再摄取抑制剂和选择性去甲肾上腺素再摄取抑制剂，比三环类抗抑郁药耐受性更好，可能会提高依从性和治疗效果。
