University Psychiatric Centre, University of Leuven, Campus Gasthuisberg, Louvain, Belgium.
University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Adv Ther. 2019 Oct;36(Suppl 3):73-90. doi: 10.1007/s12325-019-01038-w. Epub 2019 Aug 9.
A symposium held at the 31st European College of Neuropsychopharmacology congress in October 2018 in Barcelona, Spain discussed patients' expectations of treatment of their depression and how these can be integrated into patient management. Since treatment non-compliance is a major problem in patients suffering from depression, it is important to identify patients' expectations to improve treatment compliance and in turn efficacy. Currently, there is no established protocol for choosing the right antidepressant therapy, and physicians need to tailor the choice based on the type of depression, its predominant symptoms, medical and psychiatric history of patients, and their previous response to, and adverse events with, treatment. Treatment strategies also need to be adapted to each patient's personality/persona and their personal beliefs, and patients need to be aware of the potential for drug-associated adverse events such as emotional blunting, sexual dysfunction and loss of functional outcomes, as the expectation of these events may limit their impact on treatment discontinuation. Also, placebo effects remain frequent with treatment, and there is currently no agreed method for predicting response to therapy. Of the available methods to determine treatment response, pharmacogenetic testing has limited value while functional imaging may be valuable, but is not practical in routine clinical practice. Online cognitive behavioural therapy (CBT) represents a new option in the clinical management of patients with depression, particularly for patients who may not be able to access direct interaction with a psychotherapist because of the severity of their condition, their geographic location or socioeconomic situation. Online CBT can act as an adjunct to drug treatment and face-to-face psychotherapy, rather than as the sole form of treatment to aid in identifying a patient's needs, thus meeting the treatment gap and improving compliance and efficacy.Funding: Servier.
2018 年 10 月在西班牙巴塞罗那举行的第 31 届欧洲神经精神药理学学会大会上举行了一次研讨会，讨论了患者对抑郁症治疗的期望，以及如何将这些期望纳入患者管理中。由于治疗不依从是抑郁症患者的一个主要问题，因此识别患者的期望以提高治疗依从性，进而提高疗效非常重要。目前，尚无选择正确抗抑郁治疗方案的既定方案，医生需要根据抑郁症的类型、其主要症状、患者的医疗和精神病史，以及他们之前对治疗的反应和不良反应，来选择合适的治疗方案。治疗策略还需要适应每个患者的个性/人格和个人信念，患者需要意识到与药物相关的不良反应的可能性，如情绪迟钝、性功能障碍和丧失功能结果，因为对这些事件的期望可能会限制他们对治疗中断的影响。此外，治疗过程中仍然经常出现安慰剂效应，目前还没有一种公认的方法来预测对治疗的反应。在确定治疗反应的现有方法中，药物遗传学检测的价值有限，而功能成像可能具有价值，但在常规临床实践中并不实用。在线认知行为疗法（CBT）是抑郁症患者临床管理的一种新选择，尤其是对于那些由于病情严重、地理位置或社会经济状况而无法直接与心理治疗师进行互动的患者。在线 CBT 可以作为药物治疗和面对面心理治疗的辅助手段，而不是唯一的治疗形式，以帮助确定患者的需求，从而满足治疗差距，提高依从性和疗效。资金来源：Servier。
