University of California, San Diego, 3350 La Jolla Village Drive #116A, San Diego, CA 92161, USA.
Curr Psychiatry Rep. 2009 Dec;11(6):429-36. doi: 10.1007/s11920-009-0065-2.
Anxious depression has been conceptualized in at least two related but separate ways: 1) major depressive disorder with at least one comorbid Axis I anxiety disorder and 2) major depressive disorder with a high level of anxiety with or without one or more comorbid Axis I anxiety disorders. Using either definition, patients with anxious depression seem to have a more chronic course of illness, an increased incidence of suicidal thoughts and behavior, greater functional and occupational impairment, and poorer response to treatment. Multiple classes of medications are used to treat anxious depression, most commonly first- and second-generation antidepressants, atypical antipsychotics, and benzodiazepines. Certain patients with anxious depression may require lower starting doses, more gradual dose escalations, higher end point doses, longer duration of treatment, and/or early augmentation with other agents. Nonpharmacologic treatments such as targeted psychotherapy and preventative stepped-care approaches also may be effective. Well-conceived, randomized controlled treatment trials are necessary to make further gains in the management of patients with anxious depression.
1）伴有至少一种共病轴 I 焦虑障碍的重性抑郁障碍，和 2）伴有或不伴有一种或多种共病轴 I 焦虑障碍的高水平焦虑的重性抑郁障碍。使用这两种定义中的任何一种，焦虑抑郁患者的疾病病程似乎更慢性，自杀想法和行为的发生率更高，功能和职业损害更大，对治疗的反应更差。多种类别的药物被用于治疗焦虑抑郁，最常用的是第一代和第二代抗抑郁药、非典型抗精神病药和苯二氮䓬类药物。某些焦虑抑郁患者可能需要较低的起始剂量、更缓慢的剂量递增、更高的终点剂量、更长的治疗持续时间和/或早期用其他药物增效。非药物治疗，如靶向心理治疗和预防性阶梯式护理方法，也可能有效。需要精心设计的、随机对照的治疗试验，以便在焦虑抑郁患者的管理方面取得进一步进展。
