Mizukami Katsuyoshi
Department of Psychiatry, Graduate School of Comprehensive Human Sciences, University of Tsukuba.
Seishin Shinkeigaku Zasshi. 2012;114(3):289-96.
Depressive states are often observed in patients with dementia with Lewy bodies (DLB) during the clinical course and the prodromal stage. In the depressive state in patients with DLB, manifestations such as hallucinations, delusions, anxiety, hypochondria, agitation, and apathy are often found. As the differentiation of DLB and senile depression is often difficult, it is always necessary to consider the possibility of DLB for elderly patients with depression. In the pharmacotherapy for the depressive state of DLB, we should avoid using tricyclic antidepressants because of anticholinergic adverse effects. SSRIs and SNRIs are a better choice, with careful monitoring effects and side effects. Modified electro-convulsive therapy (mECT) or transcranial magnetic stimulation therapy (TMS) may be effective for pharmacotherapy-resistant cases.
路易体痴呆（DLB）患者在临床病程及前驱期常出现抑郁状态。在DLB患者的抑郁状态中，常可见幻觉、妄想、焦虑、疑病、激越及淡漠等表现。由于DLB与老年抑郁症的鉴别往往困难，对于老年抑郁症患者，始终有必要考虑DLB的可能性。在DLB抑郁状态的药物治疗中，由于抗胆碱能不良反应，应避免使用三环类抗抑郁药。选择性5-羟色胺再摄取抑制剂（SSRIs）和5-羟色胺-去甲肾上腺素再摄取抑制剂（SNRIs）是更好的选择，需仔细监测疗效及副作用。改良电休克治疗（mECT）或经颅磁刺激治疗（TMS）可能对药物治疗抵抗的病例有效。
