Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA.
CNS Drugs. 2012 Feb 1;26(2):97-109. doi: 10.2165/11599450-000000000-00000.
Depression is a recurrent illness in which afflicted individuals have an increased risk for recurrence as a function of a greater number of previous episodes. Consequently, prevention of future episodes is central to improving the prognosis. The current recommendation is to use antidepressants over prolonged periods of time to prevent further episodes of depression. However, the database for this practice is limited and can be interpreted in multiple ways. Review of the relevant literature was performed. MEDLINE and PubMed databases were searched from inception to 5 September 2011 for randomized, placebo-controlled trials of at least 18 months duration. After treatment of an acute depressive episode, antidepressants clearly prevent relapse back into the same depressive episode. This is demonstrated by an adequate number of randomized, blinded, placebo-controlled, 1-year continuation trials. The ability of antidepressants to prevent recurrence of future episodes is less clear. Randomized, blinded, placebo-controlled trials of 18 months or longer are infrequent - 18 studies were identified. While nearly all show that antidepressant continuation is superior to placebo in preventing resurgence of depressive symptoms, nearly all of the difference occurs in the first 6 months after randomization. This pattern strongly suggests that the apparent superiority of antidepressants may be due to (i) their ability to prevent recurrence, (ii) antidepressant withdrawal (characterized by depressive symptoms) in patients switched to placebo or (iii) a combination of these phenomena.
抑郁症是一种复发性疾病，受影响的个体以前发作次数越多，复发的风险就越高。因此，预防未来的发作是改善预后的关键。目前的建议是使用抗抑郁药来预防进一步的抑郁发作。然而，这种做法的数据库是有限的，并且可以有多种解释。我们对相关文献进行了回顾。在 2011 年 9 月 5 日之前，我们在 MEDLINE 和 PubMed 数据库中搜索了至少持续 18 个月的随机、安慰剂对照试验。在治疗急性抑郁发作后，抗抑郁药显然可以预防复发到同一抑郁发作。这是通过足够数量的随机、盲法、安慰剂对照、为期 1 年的延续试验证明的。抗抑郁药预防未来发作的能力则不太清楚。持续 18 个月或更长时间的随机、盲法、安慰剂对照试验很少见——只确定了 18 项研究。虽然几乎所有研究都表明抗抑郁药延续治疗在预防抑郁症状复发方面优于安慰剂，但几乎所有差异都发生在随机分组后 6 个月内。这种模式强烈表明，抗抑郁药的明显优势可能归因于（i）它们预防复发的能力，（ii）转换为安慰剂的患者出现的抗抑郁药戒断（表现为抑郁症状），或（iii）这些现象的组合。
