Institut und Poliklinik für Medizinische Psychologie, Universi -tätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
Dtsch Arztebl Int. 2010 Oct;107(40):700-8. doi: 10.3238/arztebl.2010.0700. Epub 2010 Oct 8.
Depressive disorders are among the most common illnesses and reasons for obtaining health care. Their diagnosis and treatment are still in need of improvement. In Germany, a new S3/National Clinical Practice Guideline has been developed for this purpose.
The existing guidelines on unipolar depression from Germany and other countries were synoptically compared and supplemented with systematic literature searches. After 14 consensus conferences, a total of 107 evidence-based recommendations were issued.
Unipolar depression should be diagnosed in accordance with ICD-10 criteria. Screening questionnaires are useful aids to diagnostic classification. When a treatment is chosen, shared decision-making with the patient is essential. Mild depressive episodes can be treated initially by watchful waiting for 14 days. For moderate depressive episodes, pharmacotherapy and psychotherapy are equally effective treatment options. For severe depression, a combination of pharmacotherapy and psychotherapy is recommended. If 4 to 6 weeks of acute therapy are insufficiently effective, lithium augmentation is recommended, rather than combination antidepressant therapy or a switch to another antidepressant. After remission, maintenance therapy should be continued for 4 to 9 months. In recurrent depression, pharmacotherapy and/or psychotherapy, where appropriate, should be continued for at least two years. Specific recommendations are given for patients who have somatic or mental comorbidities or are acutely suicidal, and recommendations are also given for coordination of care.
This guideline is a comprehensive set of evidence- and consensus-based recommendations for the diagnosis and treatment of unipolar depression. An improvement in the care of patients with unipolar depression will require broad implementation of the guideline, both in the inpatient and outpatient setting.
抑郁障碍是最常见的疾病和寻求医疗保健的原因之一。其诊断和治疗仍有待改进。为此，德国制定了新的 S3/国家临床实践指南。
对德国和其他国家现有的单相抑郁指南进行了综合比较，并结合系统文献检索进行了补充。经过 14 次共识会议，共发布了 107 项基于证据的建议。
单相抑郁应根据 ICD-10 标准进行诊断。筛查问卷是诊断分类的有用辅助工具。当选择治疗方法时，与患者共同决策至关重要。轻度抑郁发作可先观察等待 14 天进行初始治疗。中度抑郁发作时，药物治疗和心理治疗同样有效。对于重度抑郁，建议药物治疗和心理治疗联合。如果急性治疗 4 至 6 周效果不佳，建议锂盐增效治疗，而不是联合抗抑郁治疗或换用另一种抗抑郁药。缓解后，应继续维持治疗 4 至 9 个月。在复发性抑郁中，应根据需要继续药物治疗和/或心理治疗至少 2 年。对伴有躯体或精神共病或有急性自杀风险的患者，以及对护理协调也给出了具体的建议。
本指南是单相抑郁诊断和治疗的一套全面的基于证据和共识的建议。要改善单相抑郁患者的护理，需要在住院和门诊环境中广泛实施该指南。
