Knöchel Christian, Alves Gilberto, Friedrichs Benedikt, Schneider Barbara, Schmidt-Rechau Anna, Wenzler Sofia, Schneider Angelina, Prvulovic David, Carvalho André F, Oertel-Knöchel Viola
Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy; Heinrich- Hoffmann-Str. 10, Goethe-University, 60528 Frankfurt/Main.
Curr Neuropharmacol. 2015;13(5):577-91. doi: 10.2174/1570159x1305151013200032.
The current Review article provides a narrative review about the neurobiological underpinnings and treatment of treatment resistant late-life depression (TRLLD). The manuscript focuses on therapeutic targets of late-life depression, which include pharmacological, psychological, biophysical and exercise treatment approaches. Therefore, we summarize available evidences on that kind of therapies for patients suffering from late-life depression. The search for evidences of therapeutic options of late-life depression were done using searching websites as "pubmed", and using the searching terms "depression", "late-life depression", "treatment", "biophysical therapy", "exercise therapy", "pharmacological therapy" and "psychological therapy". To the end, we summarize and discuss current data, providing some directions for further research. Treatment recommendations for elderly depressive patients favour a multimodal approach, containing psychological, pharmacological and secondary biophysical therapeutic options. Particularly, a combination of psychotherapy and antidepressant medication reflects the best therapeutic option. However, mostly accepted and used is the pharmacological treatment although evidence suggests that the drug therapy is not as effective as it is in younger depressive patients. Further studies employing larger samples and longer follow-up periods are necessary and may focus on comparability of study designs and involve novel approaches to establish the validity and reliability of multimodal treatment programs.
当前的综述文章对难治性老年抑郁症（TRLLD）的神经生物学基础及治疗进行了叙述性综述。该手稿聚焦于老年抑郁症的治疗靶点，包括药物、心理、生物物理和运动治疗方法。因此，我们总结了针对老年抑郁症患者的此类疗法的现有证据。通过使用如“pubmed”等搜索网站，并使用搜索词“抑郁症”“老年抑郁症”“治疗”“生物物理疗法”“运动疗法”“药物疗法”和“心理疗法”来搜索老年抑郁症治疗选择的证据。最后，我们总结并讨论当前数据，为进一步研究提供一些方向。老年抑郁症患者的治疗建议倾向于多模式方法，包括心理、药物和辅助生物物理治疗选择。特别是，心理治疗和抗抑郁药物的联合是最佳治疗选择。然而，尽管有证据表明药物治疗在老年抑郁症患者中不如在年轻抑郁症患者中有效，但目前最常接受和使用的仍是药物治疗。有必要开展采用更大样本量和更长随访期的进一步研究，这些研究可侧重于研究设计的可比性，并采用新方法来确立多模式治疗方案的有效性和可靠性。
