Murphy Jenifer A, Sarris Jerome, Byrne Gerard J
ARCADIA Research Group, Professorial Unit, The Melbourne Clinic, Department of Psychiatry, University of Melbourne, Richmond, VIC, Australia.
NICM, School of Health and Science, Western Sydney University, Campbelltown, NSW, Australia.
Depress Res Treat. 2017;2017:4176825. doi: 10.1155/2017/4176825. Epub 2017 Aug 3.
Major depression does not always remit. Difficult-to-treat depression is thought to contribute to the large disease burden posed by depression. Treatment-resistant depression (TRD) is the conventional term for nonresponse to treatment in individuals with major depression. Indicators of the phenomenon are the poor response rates to antidepressants in clinical practice and the overestimation of the efficacy of antidepressants in medical scientific literature. Current TRD staging models are based on anecdotal evidence without an empirical rationale to rank one treatment strategy above another. Many factors have been associated with TRD such as inflammatory system activation, abnormal neural activity, neurotransmitter dysfunction, melancholic clinical features, bipolarity, and a higher traumatic load. This narrative review provides an overview of this complex clinical problem and discusses the reconceptualization of depression using an illness staging model in line with other medical fields such as oncology.
重度抑郁症并不总是能缓解。难治性抑郁症被认为是抑郁症造成巨大疾病负担的原因之一。治疗抵抗性抑郁症（TRD）是重度抑郁症患者对治疗无反应的传统术语。这一现象的指标包括临床实践中对抗抑郁药的低反应率以及医学科学文献中对抗抑郁药疗效的高估。当前的TRD分期模型基于轶事证据，没有将一种治疗策略置于另一种治疗策略之上的实证依据。许多因素与TRD相关，如炎症系统激活、神经活动异常、神经递质功能障碍、抑郁性临床特征、双相性以及更高的创伤负荷。这篇叙述性综述概述了这个复杂的临床问题，并讨论了使用与肿瘤学等其他医学领域一致的疾病分期模型对抑郁症进行重新概念化。
