Perlis Roy H
Center for Experimental Drugs and Diagnostics, Department of Psychiatry and Center for Human Genetic Research, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
World Psychiatry. 2016 Oct;15(3):228-235. doi: 10.1002/wps.20345.
Effectiveness studies and analyses of naturalistic cohorts demonstrate that many patients with major depressive disorder do not experience symptomatic remission with antidepressant treatments. In an effort to better match patients with effective treatments, numerous investigations of predictors or moderators of treatment response have been reported over the past five decades, including clinical features as well as biological measures. However, none of these have entered routine clinical practice; instead, clinicians typically personalize treatment on the basis of patient preferences as well as their own. Here, we review the reasons why it has been challenging to identify and deploy treatment-specific predictors of response, and suggest strategies that may be required to achieve true precision in the pharmacotherapy of depression. We emphasize the need for changes in how depression care is delivered, measured, and used to inform future practice.
对自然主义队列的有效性研究和分析表明，许多重度抑郁症患者在接受抗抑郁治疗后并未实现症状缓解。在过去的五十年里，为了更好地使患者与有效治疗方法相匹配，人们对治疗反应的预测因素或调节因素进行了大量研究，包括临床特征以及生物学指标。然而，这些研究均未进入常规临床实践；相反，临床医生通常根据患者的偏好以及他们自己的经验来进行个性化治疗。在此，我们回顾了识别和应用针对特定治疗的反应预测因素面临挑战的原因，并提出了在抑郁症药物治疗中实现真正精准治疗可能需要的策略。我们强调在抑郁症护理的提供、测量方式以及用于指导未来实践方面进行变革的必要性。
