Nunes Edward V, Levin Frances R
New York State Psychiatric Institute, 1051 Riverside Drive (Unit 51), New York, NY 10032, USA.
Curr Psychiatry Rep. 2006 Oct;8(5):363-70. doi: 10.1007/s11920-006-0037-8.
The literature on the diagnosis and treatment of depression is reviewed to arrive at recommendations for clinical practice, future research, and models of service delivery. The DSM-IV criteria are found to provide a sound basis for diagnosis, and a review of placebo-controlled trials of antidepressant medications among substance-dependent patients suggests medication is effective in the setting of careful diagnosis, preferably during a currently observed abstinent period. Clinical recommendations offered for the approach to patients with co-occurring depression and substance dependence include the following: 1) Initiate treatment for substance dependence and encourage abstinence; 2) Conduct a careful psychiatric history and apply DSM-IV criteria for primary or substance-induced depression; 3) If depression meets diagnostic criteria and persists despite treatment of substance use disorder, treat the depression. Future research should include trials of psychotherapeutic or behavioral treatments, studies of treatment algorithms and of integrated systems of care, and studies of methods for disseminating diagnostic and treatment methods in an effort to diminish traditional boundaries between the skill sets of mental health and substance abuse clinicians.
对抑郁症诊断与治疗的文献进行综述，以得出关于临床实践、未来研究及服务提供模式的建议。发现《精神疾病诊断与统计手册》第四版（DSM-IV）标准为诊断提供了可靠依据，对物质依赖患者中抗抑郁药物的安慰剂对照试验的综述表明，在仔细诊断的情况下，药物治疗是有效的，最好是在当前观察到的戒断期进行。针对同时患有抑郁症和物质依赖的患者所提供的临床建议如下：1）开始对物质依赖进行治疗并鼓励戒断；2）进行详细的精神病史询问，并应用DSM-IV标准诊断原发性或物质所致抑郁症；3）如果抑郁症符合诊断标准且尽管对物质使用障碍进行了治疗仍持续存在，则对抑郁症进行治疗。未来的研究应包括心理治疗或行为治疗的试验、治疗算法及综合护理系统的研究，以及传播诊断和治疗方法的研究，以努力消除心理健康和药物滥用临床医生技能集之间的传统界限。
