Patel Kinjal, Abdool Petal S, Rajji Tarek K, Mulsant Benoit H
a Centre for Addiction and Mental Health , Toronto , ON , Canada.
b Department of Psychiatry , Faculty of Medicine, University of Toronto , Toronto , ON , Canada.
Expert Opin Pharmacother. 2017 Apr;18(6):599-609. doi: 10.1080/14656566.2017.1308484. Epub 2017 Apr 4.
Evidence on the pharmacotherapy of late-life major depressive disorder (LLD) is scant. Most of the recommendations in existing clinical guidelines are based on expert opinions, extrapolations from data obtained in younger patients, or theoretical considerations. Areas covered: This article summarizes the recommendations from existing clinical guidelines and recent reviews on the treatment of LLD. Next, it discusses the potential role of newer antidepressants - vilazodone, levomilnacipran, and vortioxetine - based on a systematic search of the literature published during the past five years. Then, it presents evidence pertaining to the use of ketamine, aripiprazole, brexpiprazole, quetiapine, and methylphenidate in the treatment of LLD. Expert opinion: Very few recent publications directly relevant to the pharmacotherapy of LLD were identified: there are no published data supporting the use of vilazodone, levomilnacipran, ketamine, or brexpiprazole in older patients. Recent placebo-controlled randomized controlled trials (RCTs) support the use of vortioxetine, quetiapine monotherapy, aripiprazole augmentation, or methylphenidate augmentation (with one RCT for each). Thus, overall, there have been few innovations in the pharmacotherapy of LLD over the past decade and the stepwise approach recommended in older guidelines remains relevant today. More studies addressing the relative efficacy, tolerability, and safety of psychotropic medications are needed.
关于老年期重度抑郁症（LLD）药物治疗的证据很少。现有临床指南中的大多数建议是基于专家意见、从年轻患者获得的数据推断或理论考量。涵盖领域：本文总结了现有临床指南及近期关于LLD治疗的综述中的建议。接下来，基于对过去五年发表文献的系统检索，讨论新型抗抑郁药——维拉唑酮、左旋米那普明和伏硫西汀——的潜在作用。然后，介绍有关氯胺酮、阿立哌唑、布雷哌唑、喹硫平和哌甲酯在LLD治疗中应用的证据。专家意见：发现与LLD药物治疗直接相关的近期出版物极少：尚无已发表数据支持在老年患者中使用维拉唑酮、左旋米那普明、氯胺酮或布雷哌唑。近期安慰剂对照随机对照试验（RCT）支持使用伏硫西汀、喹硫平单药治疗、阿立哌唑增效或哌甲酯增效（各有一项RCT）。因此，总体而言，在过去十年中LLD药物治疗几乎没有创新，旧指南中推荐的逐步治疗方法如今仍然适用。需要更多研究来探讨精神药物的相对疗效、耐受性和安全性。
