Departments of Psychiatry and Radiology, Columbia University, New York, NY, USA.
Sheppard Pratt Health System and Department of Psychiatry, University of Maryland, Baltimore, MD, USA.
J Psychiatr Res. 2019 Jun;113:125-136. doi: 10.1016/j.jpsychires.2019.03.021. Epub 2019 Mar 22.
There is considerable diversity in how treatment-resistant depression (TRD) is defined. However, every definition incorporates the concept that patients with TRD have not benefited sufficiently from one or more adequate trials of antidepressant treatment. This review examines the issues fundamental to the systematic evaluation of antidepressant treatment adequacy and resistance. These issues include the domains of interventions deemed effective in treatment of major depressive episodes (e.g., pharmacotherapy, brain stimulation, and psychotherapy), the subgroups of patients for whom distinct adequacy criteria are needed (e.g., bipolar vs. unipolar depression, psychotic vs. nonpsychotic depression), whether trials should be rated dichotomously as adequate or inadequate or on a potency continuum, whether combination and augmentation strategies require specific consideration, and the criteria used to evaluate the adequacy of treatment delivery (e.g., dose, duration), trial adherence, and clinical outcome. This review also presents the Antidepressant Treatment History Form: Short-Form (ATHF-SF), a completely revised version of an earlier instrument, and details how these fundamental issues were addressed in the ATHF-SF.
治疗抵抗性抑郁症（TRD）的定义存在相当大的差异。然而，每种定义都包含这样一种概念，即患有 TRD 的患者从一种或多种充分的抗抑郁治疗试验中获益不足。这篇综述考察了系统评估抗抑郁治疗充分性和抵抗性的基本问题。这些问题包括被认为对治疗重性抑郁发作有效的干预领域（例如，药物治疗、脑刺激和心理治疗）、需要特定充分性标准的患者亚组（例如，双相情感障碍与单相情感障碍、精神病性与非精神病性抑郁）、试验是否应被分为充分或不充分，还是应在效力连续体上进行评分、是否需要特别考虑联合和增效策略，以及用于评估治疗提供的充分性（例如，剂量、持续时间）、试验依从性和临床结局的标准。这篇综述还介绍了抗抑郁治疗史表格：短表（ATHF-SF），这是早期工具的完全修订版本，并详细说明了这些基本问题在 ATHF-SF 中是如何得到解决的。
