Bonin-Guillaume Sylvie, Blin Olivier
Service de médecine interne gériatrique Assistance publique des hôpitaux de Marseille, France.
Psychol Neuropsychiatr Vieil. 2004 Sep;2 Suppl 1:S61-8.
Depression has a high prevalence and a poor outcome in the aged. However, it is often under diagnosed and under treated although treatment with antidepressants at optimal dose and duration can be effective on full remission. Numerous antidepressants are effective but most of them produce side effects. The choice of antidepressants must take into account the effect of age on side-effects and pharmacokinetics. IRSS or moclobemide are recommended as first-choice antidepressants because of a presumed side effect better profile. A dimensional approach based on neurobiological hypothesis of depression, specific clinical features of late life depression (e.g. psychomotor retardation) and biological target of the antidepressants should promote treatment efficacy.
抑郁症在老年人中患病率高且预后不佳。然而,尽管以最佳剂量和疗程使用抗抑郁药进行治疗可实现完全缓解,但该病往往诊断不足且治疗不足。许多抗抑郁药都有效,但其中大多数会产生副作用。抗抑郁药的选择必须考虑年龄对副作用和药代动力学的影响。由于假定副作用较小,异卡波肼或吗氯贝胺被推荐为首选抗抑郁药。基于抑郁症的神经生物学假说、老年抑郁症的特定临床特征(如精神运动迟缓)以及抗抑郁药的生物学靶点的维度方法应能提高治疗效果。