Department of Psychiatry, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Curr Pharm Des. 2020;26(2):244-252. doi: 10.2174/1381612826666200110101604.
In this narrative review, we intended to summarize the evidence of pharmacological and somatic treatment choices for treatment-resistant depression (TRD). There are several types of therapeutic strategies to improve inadequate response to antidepressant treatment. The first step for patients with TRD is to optimize the dosage and duration of antidepressants as well as to ensure their drug compliance. The shift to antidepressant and antidepressant combination therapy for patients with TRD cannot be regarded as an evidence-based strategy. Only the combination of a monoamine reuptake inhibitor with a presynaptic α2-autoreceptor antagonist might have better efficacy than other antidepressant combinations. Currently, the most evidence-based treatment options for TRD are augmentation strategies. Among augmentative agents, second-generation antipsychotics and lithium have the strongest evidence for the management of TRD. Further studies are needed to evaluate the augmentative efficacy of anticonvulsants, thyroid hormone, glutamatergic agents, anti-inflammatory agents, and nutraceuticals for TRD. Among somatic therapies, electroconvulsive therapy and repetitive transcranial magnetic stimulation are effective for TRD. Further studies are warranted to provide clinicians with a better recommendation in making treatment choices in patients with TRD.
在这篇叙述性评论中，我们旨在总结治疗抵抗性抑郁症（TRD）的药物和躯体治疗选择的证据。有几种治疗策略可以改善抗抑郁治疗反应不足的情况。对于 TRD 患者，第一步是优化抗抑郁药的剂量和持续时间，并确保其药物依从性。对于 TRD 患者，将抗抑郁药和抗抑郁药联合治疗转换为不能被视为基于证据的策略。只有单胺再摄取抑制剂与突触前 α2-自身受体拮抗剂联合使用可能比其他抗抑郁药联合治疗更有效。目前，TRD 最基于证据的治疗选择是增效策略。在增效剂中，第二代抗精神病药和锂对 TRD 的治疗有最强的证据支持。需要进一步研究评估抗惊厥药、甲状腺激素、谷氨酸能药物、抗炎药和 TRD 的营养保健品的增效疗效。在躯体治疗中，电惊厥治疗和重复经颅磁刺激对 TRD 有效。需要进一步的研究为临床医生在治疗 TRD 患者时提供更好的治疗选择建议。
