Trivedi Madhukar H, Hollander Eric, Nutt David, Blier Pierre
Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, TX 75235, USA.
J Clin Psychiatry. 2008 Feb;69(2):246-58. doi: 10.4088/jcp.v69n0211.
Recent data indicate that more than 65% of patients with major depressive disorder (MDD) fail to achieve remission. This article reviews research on the current understanding and management of residual symptoms, i.e., subthreshold depressive symptoms present after recovery from a major depressive episode.
MEDLINE (1966 to June 2006) was searched using combinations of the following search terms: major depressive disorder, residual symptoms, remission, response, tachyphylaxis, antidepressant, algorithm, treatment, responsiveness, serotonin, norepinephrine, and dopamine.
All relevant articles that were published in English and reported original study data related to residual symptoms in MDD were included.
Studies were examined for data related to the prevalence, presentation, consequences, treatment, and neurobiological underpinnings of residual symptoms associated with MDD.
Residual symptoms are common among patients treated for MDD who do not achieve full remission. Incomplete remission is associated with increased risk of relapse, suicide, functional impairment, and higher use of health care resources. Several factors, including "downstream" neurochemical mechanisms and clinical factors such as lack of adherence, contribute to the high prevalence of residual symptoms. Various clinical strategies, including switching and substitution antidepressant therapies, are used to address unresolved depressive symptoms. Individual differences in therapeutic response contribute to inadequate treatment and are linked to numerous clinical and neurobiological factors, including noncompliance, underdosing, intolerance, disturbances in neural circuitry, and genetic variability in neurotransmitters.
Future research is needed to more precisely characterize residual symptoms and their underlying biochemical and molecular mechanisms in order to develop more effective treatment methods.
近期数据表明，超过65%的重度抑郁症（MDD）患者未能实现症状缓解。本文综述了关于残留症状（即重度抑郁发作康复后仍存在的阈下抑郁症状）的当前认识及管理的研究。
使用以下搜索词的组合在MEDLINE（1966年至2006年6月）中进行检索：重度抑郁症、残留症状、缓解、反应、快速耐受、抗抑郁药、算法、治疗、反应性、血清素、去甲肾上腺素和多巴胺。
纳入所有以英文发表并报告了与MDD残留症状相关的原始研究数据的相关文章。
对研究进行审查，以获取与MDD相关残留症状的患病率、表现、后果、治疗及神经生物学基础相关的数据。
残留症状在未实现完全缓解的MDD治疗患者中很常见。不完全缓解与复发、自杀、功能损害风险增加以及医疗资源使用增加有关。包括“下游”神经化学机制和缺乏依从性等临床因素在内的几个因素导致了残留症状的高患病率。各种临床策略，包括更换和替代抗抑郁治疗，用于解决未解决的抑郁症状。治疗反应的个体差异导致治疗不足，并与许多临床和神经生物学因素相关，包括不依从、剂量不足、不耐受、神经回路紊乱以及神经递质的基因变异性。
需要未来的研究来更精确地表征残留症状及其潜在的生化和分子机制，以便开发更有效的治疗方法。
