Koukopoulos A, Sani G, Koukopoulos A E, Manfredi G, Pacchiarotti I, Girardi P
Centro Lucio Bini, Center for the Treatment and Research of Affective Disorders and Department of Psychiatry, University of Rome La Sapienza, c/o Sant'Andrea Hospital, Rome, Italy.
Acta Psychiatr Scand Suppl. 2007(433):50-7. doi: 10.1111/j.1600-0447.2007.00963.x.
The diagnostic entity of major depressive episode includes both simple and agitated or mixed depression. Mixed depression is characterized by a full depressive episode with several symptoms of excitatory nature. Mixed depressions worsen if treated with antidepressants.
We have reviewed the clinical charts of the 2141 patients treated at the Centro Lucio Bini of Rome from January 1999 to June 2006. These patients were diagnosed according to DSM-IV criteria. Research diagnostic criteria were applied for agitated depression with motor agitation and Author's diagnostic criteria for agitated depression without motor agitation.
One thousand and twenty-six patients had a depressive episode as index episode. Three hundred and forty six (33%) were mixed depressive states. One hundred and thirty eight (44%) of them were spontaneous; in 173 cases, the onset of the mixed depression was associated with antidepressants.
Psychic and motor agitation are considered equally important for the definition of agitated depression. Treating agitated depression with antidepressants worsens the clinical picture. The use of Electroconvulsive Therapy (ECT), neuroleptics and anticonvulsants are recommended. The term Melancholia Agitata is proposed for agitated (mixed) depression.
重度抑郁发作的诊断实体包括单纯性抑郁以及激越性或混合性抑郁。混合性抑郁的特征为伴有多种兴奋性症状的完全性抑郁发作。若使用抗抑郁药治疗，混合性抑郁会加重。
我们回顾了1999年1月至2006年6月在罗马卢西奥·比尼中心接受治疗的2141例患者的临床病历。这些患者根据《精神疾病诊断与统计手册》第四版（DSM-IV）标准进行诊断。对于伴有运动性激越的激越性抑郁应用研究诊断标准，对于无运动性激越的激越性抑郁应用作者的诊断标准。
1026例患者以抑郁发作作为索引发作。其中346例（33%）为混合性抑郁状态。其中138例（44%）为自发性；173例中，混合性抑郁的发作与抗抑郁药有关。
精神和运动性激越对于激越性抑郁的定义同样重要。使用抗抑郁药治疗激越性抑郁会使临床症状恶化。推荐使用电休克治疗（ECT）、抗精神病药和抗惊厥药。建议将“激越性忧郁症”这一术语用于激越性（混合性）抑郁。
