University of Pittsburgh Medical Center, Western Psychiatric Institute and Clinic, PA, USA.
Lancet. 2012 Mar 17;379(9820):1045-55. doi: 10.1016/S0140-6736(11)60602-8. Epub 2011 Dec 19.
In this Seminar we discuss developments from the past 5 years in the diagnosis, neurobiology, and treatment of major depressive disorder. For diagnosis, psychiatric and medical comorbidity have been emphasised as important factors in improving the appropriate assessment and management of depression. Advances in neurobiology have also increased, and we aim to indicate genetic, molecular, and neuroimaging studies that are relevant for assessment and treatment selection of this disorder. Further studies of depression-specific psychotherapies, the continued application of antidepressants, the development of new treatment compounds, and the status of new somatic treatments are also discussed. We address two treatment-related issues: suicide risk with selective serotonin reuptake inhibitors, and the safety of antidepressants in pregnancy. Although clear advances have been made, no fully satisfactory treatments for major depression are available.
在本次研讨会中，我们讨论了过去 5 年来在重度抑郁症的诊断、神经生物学和治疗方面的进展。在诊断方面，精神科和医学共病已被强调为改善抑郁的恰当评估和管理的重要因素。神经生物学的进展也有所增加，我们旨在指出与该疾病的评估和治疗选择相关的遗传、分子和神经影像学研究。进一步研究特定于抑郁症的心理治疗、继续应用抗抑郁药、开发新的治疗化合物以及新躯体治疗的现状也在讨论之中。我们讨论了与治疗相关的两个问题：选择性 5-羟色胺再摄取抑制剂的自杀风险，以及抗抑郁药在妊娠期间的安全性。尽管已经取得了明显的进展，但仍没有完全令人满意的重度抑郁症治疗方法。
