Pies Ronald
Professor of Psychiatry, SUNY Upstate Medical University, Syracuse, New York, USA.
Innov Clin Neurosci. 2012 May;9(5-6):31-40.
The efficacy of antidepressant treatment of major depression remains a matter of controversy. A review of acute treatment studies suggests that for relatively more severe episodes of major depression, antidepressants are superior to treatment in the "placebo group;" however, there are numerous methodological confounds in the available literature. (Some recent, preliminary evidence suggests that antidepressants may also be of benefit in some less severely depressed populations).There is moderately strong evidence that, compared with placebo, maintenance antidepressant treatment reduces six-month relapse rates in major depression; however, it is less clear that antidepressants prevent actual recurrence of depression in the longer term. There is evidence of both over-use and under-use of antidepressant treatment, and there appears to be a "mismatch" between diagnosis and optimal treatment of depression in some clinical settings. Better designed studies are needed to resolve these uncertainties and to investigate such putative conditions as "oppositional tolerance" to long-term antidepressant treatment. The author advocates a conservative approach to antidepressant treatment, as well as a substantially extended "tapering" period when antidepressants are discontinued.
重度抑郁症抗抑郁治疗的疗效仍存在争议。对急性治疗研究的综述表明，对于相对更严重的重度抑郁发作，抗抑郁药优于“安慰剂组”的治疗；然而，现有文献中存在众多方法学上的混淆因素。（一些近期的初步证据表明，抗抑郁药在一些病情不太严重的抑郁人群中可能也有益处）。有中等强度的证据表明，与安慰剂相比，维持性抗抑郁治疗可降低重度抑郁症的六个月复发率；然而，长期来看抗抑郁药能否预防抑郁症的实际复发尚不太明确。有证据表明抗抑郁治疗存在过度使用和使用不足的情况，并且在某些临床环境中，抑郁症的诊断与最佳治疗之间似乎存在“不匹配”。需要设计更完善的研究来解决这些不确定性，并研究诸如对长期抗抑郁治疗的“对抗性耐受”等假定情况。作者主张对抗抑郁治疗采取保守方法，以及在停用抗抑郁药时大幅延长“逐渐减量”期。
