de Hooge J K
Deltaziekenhuis, Poortugaal.
Tijdschr Gerontol Geriatr. 1990 Dec;21(6):259-67.
Depressive disorders are the most common psychiatric illness in the elderly. All tricyclic antidepressants show comparable therapeutic efficacy, thus the choice of drug is based on their side effects profiles rather than on degree of therapeutic efficacy. The secondary amines nortriptyline and desipramine are drugs of choice for the elderly depressive patient because of their relatively mild side effects profile. New-generation antidepressants remain second choice. Patients suffering from a psychotic depression often require a combination of an antidepressant drug with an antipsychotic drug. Addition of lithium to a cyclic antidepressant can produce a rapid and lasting remission in patients with a major depressive disorder who do not respond to a cyclic antidepressant alone. Treatment with MAO-inhibitors or electroconvulsive therapy can also be considered in refractory cases.
抑郁症是老年人中最常见的精神疾病。所有三环类抗抑郁药都显示出相当的治疗效果，因此药物的选择基于其副作用特征而非治疗效果的程度。二级胺类的去甲替林和地昔帕明是老年抑郁症患者的首选药物，因为它们的副作用相对较轻。新一代抗抑郁药仍是第二选择。患有精神病性抑郁症的患者通常需要将抗抑郁药与抗精神病药联合使用。对于单独使用三环类抗抑郁药无效的重度抑郁症患者，在三环类抗抑郁药中添加锂可产生快速而持久的缓解。难治性病例也可考虑使用单胺氧化酶抑制剂或电休克疗法进行治疗。
