Kral V A
J Gerontol. 1976 May;31(3):311-3. doi: 10.1093/geronj/31.3.311.
While psychotherapy is the treatment of choice in neurotic situational depressions of older patients, it is not effective enough in endogenous bipolar or monopolar depression of elderly. These respond better to somatic therapy, mainly pharmacotherapy, or, if necessary, ECT. Experience shows the aged endogenous depressions respond favorably to tricyclic antidepressants as well as to mono-amino oxidase inhibitors, although the dosage may have to be kept lower than with younger patients. ECT, if necessary, is well tolerated and effective in aged patients. However, proper precautions have to be taken before this treatment is commenced. Patients with a history or signs of recent coronary thrombosis or decompensated heart failure should be excluded. Also, the number of treatments should be kept at a minimum. The individual treatments should be spaced farther apart and so-called "intensive treatment" avoided. If an endogenous depression lasts for more than 2 years and does not respond to any other kind of treatment, psychosurgery may have to be considered. Experience has shown that long-lasting, deep depressions of the aged can be helped by this method without any important personality change.
虽然心理治疗是老年患者神经症性情境性抑郁的首选治疗方法，但对老年内源性双相或单相抑郁的疗效不够显著。这些类型的抑郁对躯体治疗反应更好，主要是药物治疗，必要时可采用电休克治疗（ECT）。经验表明，老年内源性抑郁对三环类抗抑郁药和单胺氧化酶抑制剂反应良好，尽管剂量可能需要低于年轻患者。如有必要，ECT在老年患者中耐受性良好且有效。然而，在开始这种治疗之前必须采取适当的预防措施。有近期冠状动脉血栓形成病史或体征或失代偿性心力衰竭的患者应排除在外。此外，治疗次数应保持在最低限度。每次治疗间隔应更长，避免所谓的“强化治疗”。如果内源性抑郁持续超过2年且对任何其他治疗均无反应，则可能不得不考虑心理外科手术。经验表明，这种方法可以帮助老年患者缓解长期、严重的抑郁，且不会导致任何重要的人格改变。
