Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA.
CNS Drugs. 2013 May;27 Suppl 1:S29-37. doi: 10.1007/s40263-012-0031-0.
There is a growing body of evidence that supports the use of atypical antipsychotics as augmentation agents for nonpsychotic unipolar major depressive disorder (MDD) in adults. Unfortunately, varying definitions of treatment-resistant depression, the limited evidence available for interventions after two or more treatment failures, and when and whether to use medications from nonantidepressant classes, remain a key gap in the knowledge base for clinicians. We identified and reviewed the following guidelines to discuss the status of augmentation therapy with atypical antipsychotic agents in MDD: American Psychiatric Association practice guidelines for treatment of patients with MDD; Canadian Network for Mood and Anxiety Treatments clinical guidelines for the management of MDD in adults; National Institute for Health and Clinical Excellence guidelines for treatment and management of depression in adults; British Association of Psychopharmacology guidelines for treatment of depressive disorders; Institute for Clinical Systems Improvement healthcare guideline for MDD in adults in primary care; clinical practice recommendations for depression; international consensus statement on MDD; German Society of Psychiatry, Psychotherapy and Neurology guidelines for unipolar depression; and World Federation of Societies of Biological Psychiatry guidelines for biological treatment of unipolar depressive disorders in primary care. Reflecting the cumulative evidence in the past decade, augmentation strategies including atypical antipsychotic augmentation are recommended in most guidelines for partial or nonresponders, at the same stage as switching or combination strategies. However, there are few direct comparisons of different augmentation strategies and little information about the optimal duration of augmentation strategies or use in special populations. Clinicians should note that guidelines are derived from an evolving database of evidence and cannot take into account the myriad of clinical variables that differ between individual patients. Therefore, they are intended to provide a useful framework for the management of depression and should be used in conjunction with other recognized sources of patient information and the application of clinical wisdom.
越来越多的证据支持在成人非精神病性单相重度抑郁症（MDD）中使用非典型抗精神病药作为增效剂。不幸的是，治疗抵抗性抑郁症的定义不同、两次或多次治疗失败后的干预措施的证据有限、何时以及是否使用非抗抑郁药类药物，这些仍然是临床医生知识库中的一个关键空白。我们确定并审查了以下指南，以讨论在 MDD 中使用非典型抗精神病药物增效治疗的现状：美国精神病学协会治疗 MDD 患者的实践指南；加拿大情绪和焦虑治疗网络成人 MDD 管理临床指南；英国国家卫生与临床优化研究所成人抑郁症治疗和管理指南；英国精神病学协会治疗抑郁障碍指南；改善医疗保健指南协会成人 MDD 初级保健指南；抑郁症临床实践建议；MDD 国际共识声明；德国精神病学、心理治疗和神经病学协会单相抑郁症指南；世界生物精神病学协会初级保健中非典型抗精神病药物增效治疗的生物治疗指南。反映过去十年中的累积证据，大多数指南都建议在部分或无反应者中，在转换或联合策略的同一阶段，使用增效策略，包括非典型抗精神病药增效。然而，很少有不同增效策略的直接比较，也很少有关于增效策略的最佳持续时间或在特殊人群中的使用的信息。临床医生应注意，指南是从不断发展的证据数据库中得出的，不能考虑到每个患者之间存在的无数临床变量。因此，它们旨在为抑郁症的管理提供一个有用的框架，并应与其他公认的患者信息来源以及临床智慧的应用一起使用。
