Berlim Marcelo T, Fleck Marcelo P, Turecki Gustavo
Depressive Disorders Program, and the McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montréal, Québec, Canada.
Ann Med. 2008;40(2):149-59. doi: 10.1080/07853890701769728.
A significant proportion of depressed patients eventually present with treatment-resistant/refractory major depression (TRD), a debilitating condition that imposes significant health, social, and economic burdens. Recently, a growing level of consensus has been reached on the general meaning of TRD, according to which, depression is considered resistant when at least two trials with antidepressants from different pharmacologic classes (adequate in terms of dose, duration, outcome, and compliance) failed to achieve clinical remission. Regarding the management of TRD, a two-step approach is suggested, involving first the evaluation of factors that may contribute to treatment nonresponse (such as comorbid medical and psychiatric conditions), and second, the use of the four classical strategies for enhancing antidepressant efficacy (namely optimization, augmentation, combination, and switching). Finally, future research on TRD should include studies addressing, among other issues, the validity of the proposed definitional criteria, the evaluation of reliable predictors of treatment outcome, and the development of novel therapeutic strategies.
相当一部分抑郁症患者最终会出现难治性/顽固性重度抑郁症（TRD），这是一种使人衰弱的病症，会带来重大的健康、社会和经济负担。最近，人们对TRD的一般含义已达成越来越多的共识，据此，当至少两项使用不同药理类别的抗抑郁药（在剂量、疗程、疗效和依从性方面足够）的试验未能实现临床缓解时，抑郁症被认为具有抗药性。关于TRD的管理，建议采用两步法，首先评估可能导致治疗无反应的因素（如合并的医学和精神疾病），其次使用增强抗抑郁药疗效的四种经典策略（即优化、增效、联合和换药）。最后，未来关于TRD的研究应包括解决其他问题的研究，如所提议定义标准的有效性、治疗结果可靠预测指标的评估以及新型治疗策略的开发。
