J Psychopharmacol. 1993 Jan;7(1 Suppl):19-23. doi: 10.1177/0269881193007001041.
Depression is a common illness which affects some 3% of the population per year. At least 25% of those with marked depression do not consult their general practitioner and in half of those who do the illness is not detected. Depression is easy to recognize when four or five of the core symptoms have been present for 2 weeks which often coincides with some occupational and social impairment. The core symptoms are depressed mood, loss of interest or pleasure, loss of energy or fatigue, concentration difficulties, appetite disturbance, sleep disturbance, agitation or retardation, worthlessness or self blame and suicidal thoughts. A diagnosis of depression is made when five of these core symptoms, one of which should be depressed mood or loss of interest or pleasure, have been present for 2 weeks. Four core symptoms are probably sufficient. Response to antidepressants is good in those with more than mild symptoms. When there are only few or very mild depressive symptoms evidence of response to antidepressants is more uncertain. Antidepressants are effective, they are not addictive and do not lose efficacy with prolonged use. The newer antidepressants have fewer side effects than the older tricyclics, they are better tolerated and lead to less withdrawals from treatment. They are less cardiotoxic and are safer in overdose. Antidepressants should be used at full therapeutic doses. Treatment failure is often due to too low a dose being used in general practice. It may be difficult to reach the right dose with the older tricyclics because of side effects. To consolidate response, treatment should be continued for at least 4 months after the patient is apparently well. Stopping the treatment before this is ill-advised as the partially treated depression frequently returns. Most depression is recurrent. Long-term antidepressant treatment is effective in reducing the risk of new episodes of depression and should be continued to keep the patient well.
抑郁症是一种常见疾病，每年影响约 3%的人口。至少有 25%的重度抑郁症患者未咨询全科医生，而在就诊的患者中，有一半未被发现患有抑郁症。当出现以下四种或五种核心症状且持续两周以上，且通常伴有一些职业和社会功能损害时，很容易识别出抑郁症：情绪低落、兴趣或愉悦感丧失、精力或疲劳感丧失、注意力困难、食欲紊乱、睡眠障碍、烦躁不安或行动迟缓、无价值感或自责、自杀念头。当出现以下五种核心症状，其中一种必须是情绪低落或兴趣或愉悦感丧失，且持续两周以上时，即可诊断为抑郁症。四种核心症状可能就足够了。对于那些症状较为严重的患者，抗抑郁药的治疗效果良好。对于那些仅有少数或非常轻微抑郁症状的患者，抗抑郁药的疗效则更为不确定。抗抑郁药有效，它们不会成瘾，也不会因长期使用而失去疗效。新型抗抑郁药比旧的三环抗抑郁药副作用更少，患者的耐受性更好，停药反应更少。它们对心脏的毒性较小，过量服用也更安全。抗抑郁药应在治疗剂量下使用。治疗失败通常是由于全科医生使用的剂量过低。由于副作用，可能很难达到旧的三环抗抑郁药的正确剂量。为了巩固疗效，患者在明显好转后应继续治疗至少 4 个月。在这之前停药是不明智的，因为部分治疗的抑郁症经常会复发。大多数抑郁症是复发性的。长期使用抗抑郁药治疗可有效降低新发作的风险，应继续治疗以保持患者的健康。
