Thase Michael E
Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia Veterans Affairs Medical Center, and Pittsburgh Medical Center, Philadelphia and Pittsburgh, USA.
J Clin Psychiatry. 2009;70 Suppl 6:4-9. doi: 10.4088/JCP.8133su1c.01.
Full symptomatic remission is the optimal outcome for patients with major depression. Unfortunately, antidepressant efficacy is limited to partial response for a significant minority of patients. Incomplete remission of depressive symptoms is associated with increased risk of relapse, decreased functioning in work and social settings, and increased risk of eventual suicide. Factors that increase the likelihood of incomplete remission include chronicity, severe symptomatology, and comorbid illnesses. Strategies to manage incomplete remission include "watchful waiting" (ie, continuing the original medication for another 4 to 8 weeks to see if complete remission will develop), switching antidepressants, or adding a second, adjunctive treatment (ie, either beginning psychotherapy or a second medication to augment the original antidepressant). Augmentation strategies may well prove to be the preferred strategy for improving response if tolerability is not an issue. Although studies on predictive factors have not yielded definitive results, clinicians in practice often select adjunctive agents that target patients' persistent symptoms.
完全症状缓解是重度抑郁症患者的最佳治疗结果。不幸的是，对于相当一部分患者而言，抗抑郁药的疗效仅限于部分缓解。抑郁症状不完全缓解与复发风险增加、工作和社交功能下降以及最终自杀风险增加有关。导致不完全缓解可能性增加的因素包括病程慢性化、症状严重以及共病。处理不完全缓解的策略包括“密切观察等待”（即继续使用原药物治疗4至8周，观察是否会出现完全缓解）、更换抗抑郁药或添加第二种辅助治疗（即开始心理治疗或使用第二种药物增强原抗抑郁药的疗效）。如果耐受性不成问题，增强策略很可能被证明是改善疗效的首选策略。尽管关于预测因素的研究尚未得出明确结果，但临床医生在实践中通常会选择针对患者持续症状的辅助药物。
