Ford Andrew H, Almeida Osvaldo P
School of Psychiatry and Clinical Neurosciences (M573), Western Australian Centre for Health and Ageing (M573), Harry Perkins Institute of Medical Research, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.
Drugs Aging. 2017 Feb;34(2):89-95. doi: 10.1007/s40266-016-0434-6.
Depression in the context of dementia is common and contributes to poorer outcomes in individuals and those who care for them. Non-pharmacological treatments are the preferred initial approach to managing these symptoms but data in support of these are scarce. There are a number of pharmacological treatment options available to clinicians but efficacy is uncertain and concern about potential side effects in an aging and vulnerable population needs to be taken into consideration. This review aims to provide a concise overview of pharmacological treatments for depression in dementia. Antidepressants are the mainstay of pharmacological treatment for clinically significant depression in the general population but evidence to support their use in dementia is mixed. Trials of antidepressants should generally be reserved for individuals with depression where the symptoms are distressing and surpass the threshold for major depression. Acetylcholinesterase inhibitors and memantine are effective in the symptomatic treatment of Alzheimer's disease but current evidence does not support their use to treat depressive symptoms in dementia. Similarly, antipsychotics and mood stabilizers have no proven efficacy for depression and the risk of adverse effects seems to outweigh any potential benefit. Pain can be a frequent problem in dementia and may have significant effects on behavior and mood. Preliminary evidence supports a role of adequate analgesia in improving mood in people with dementia.
痴呆症患者中抑郁症很常见，会导致患者本人及其照料者的预后更差。非药物治疗是管理这些症状的首选初始方法，但支持这些方法的数据很少。临床医生有多种药物治疗选择，但疗效不确定，且需要考虑老年脆弱人群中潜在副作用的问题。本综述旨在简要概述痴呆症抑郁症的药物治疗。抗抑郁药是一般人群中治疗具有临床意义抑郁症的药物治疗的主要手段，但支持其用于痴呆症治疗的证据不一。抗抑郁药试验通常应仅用于症状令人痛苦且超过重度抑郁症阈值的抑郁症患者。乙酰胆碱酯酶抑制剂和美金刚对阿尔茨海默病的症状治疗有效，但目前证据不支持它们用于治疗痴呆症的抑郁症状。同样，抗精神病药和心境稳定剂对抑郁症没有已证实的疗效，且不良反应风险似乎超过任何潜在益处。疼痛在痴呆症中可能是一个常见问题，可能对行为和情绪产生重大影响。初步证据支持充分镇痛在改善痴呆症患者情绪方面的作用。
