Thase Michael E
Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
J Clin Psychiatry. 2003;64 Suppl 18:3-7.
Although antidepressants are effective, no more than one third of the depressed patients who begin treatment achieve full remission within 8 weeks of therapy. Remission, defined as virtually complete relief of symptoms and return to full functioning in all areas of life, should be thought of as the optimal goal for the initial phase of treatment of depression. This goal is recommended because residual symptoms (i.e., response without remission) are associated with a myriad of risks, including a higher rate of relapse. When compared with monotherapy, selective serotonin reuptake inhibitor (i.e., the current first-line standard of care) strategies may improve remission rates. These strategies include using maximally tolerated (i.e., higher than usual) doses of medication, switching to an antidepressant thought to have more than one mechanism of action, combining dissimilar medications (to presumably treat a broader range of symptoms), and using a combination of psychotherapy and medication. Ensuring that patients are indeed adherent with treatment is also worthwhile before assuming that a treatment has failed.
尽管抗抑郁药是有效的，但开始治疗的抑郁症患者中，不超过三分之一能在治疗8周内实现完全缓解。缓解被定义为症状几乎完全缓解并恢复到生活各方面的完全功能状态，应被视为抑郁症初始治疗阶段的最佳目标。推荐这个目标是因为残留症状（即有反应但未缓解）与众多风险相关，包括更高的复发率。与单一疗法相比，选择性5-羟色胺再摄取抑制剂（即当前的一线标准治疗方法）策略可能提高缓解率。这些策略包括使用最大耐受剂量（即高于通常剂量）的药物、换用一种被认为有多种作用机制的抗抑郁药、联合不同药物（大概是为了治疗更广泛的症状）以及使用心理治疗和药物联合治疗。在认定一种治疗失败之前，确保患者确实坚持治疗也是值得的。
