Mouchabac S
Département de psychiatrie et de psychologie médicale, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris.
Encephale. 2009 Dec;35 Suppl 7:S319-24. doi: 10.1016/S0013-7006(09)73495-5.
Depression is a common illness with a large clinical phenotype, and clinicians have numerous guidelines to treat this disorder : many antidepressant drugs are available with different pharmacological profiles and stepped strategies are proposed to obtain a remission. It exists a relationship between baseline depression symptom severity and treatment response and patient with higher levels of severity received significantly more intervention visits, more months of antidepressant treatment and more antidepressant trials, but there is not accepted and consensual definition for severe depression. By using cut-off scores on rating scales severe depression is at one extreme of a continuum of severity (but scales which serve for quantifying the intensity of the depression with thresholds present an interest and also limits, in the current practice, they are rarely used), in the other hand some symptoms contributes to severity (psychotics features, suicidal ideation), evolution and prognosis is a part of severity too (recurrences, chronicity), severe depression can influence a somatic pathology contributing to severity (could be considered itself as a major risk factor) and have an impact on treatment outcome, finally by its role on morbi-mortality and handicap, depression is often a severe disorder. So, concerning the therapeutic choices, there are few data to choose specific options because the concept of severity in the depression is not still clearly defined in studies and few randomized contolled studies have been done in this indication and adapted to different modality of the severity expression. Symptom-free remission is a goal for treatment in severe depression, but complications have to be considered in medication algorithms. In this paper, we review the modalities of prescription of antidepressants according to these differences of the severity in depression.
抑郁症是一种具有广泛临床表型的常见疾病，临床医生有众多治疗该疾病的指南：有多种具有不同药理学特征的抗抑郁药物可供使用，并提出了逐步治疗策略以实现缓解。基线抑郁症状严重程度与治疗反应之间存在关联，症状严重程度较高的患者接受的干预就诊次数显著更多、抗抑郁治疗的月数更多且进行的抗抑郁试验更多，但对于重度抑郁症尚无公认且一致的定义。通过使用评分量表的临界值，重度抑郁症处于严重程度连续体的一端（但用于通过阈值量化抑郁强度的量表既有优点也有局限性，在当前实践中很少使用），另一方面，一些症状会导致严重程度增加（精神病性特征、自杀观念），病情演变和预后也是严重程度的一部分（复发、慢性化），重度抑郁症可影响躯体疾病从而加重严重程度（可将其本身视为一个主要危险因素）并对治疗结果产生影响，最后，由于其对发病率和死亡率以及残疾的影响，抑郁症通常是一种严重的疾病。因此，关于治疗选择，可供选择特定方案的数据很少，因为抑郁症严重程度的概念在研究中仍未明确界定，且针对该适应症进行的、适用于不同严重程度表达方式的随机对照研究很少。症状缓解是重度抑郁症治疗的目标，但在用药方案中必须考虑并发症。在本文中，我们根据抑郁症严重程度的这些差异综述抗抑郁药的处方方式。
