Mitchell P
School of Psychiatry, University of New South Wales.
Aust N Z J Psychiatry. 1987 Dec;21(4):442-51. doi: 10.3109/00048678709158911.
Despite the introduction of a wide range of antidepressant drugs since the late 1950s, approximately 30-50% of depressed subjects do not respond to these agents. Various treatment strategies, both pharmacological and non-pharmacological, have been proposed for treatment-resistant depression. This paper critically reviews the studies of single and combined pharmacological treatments for tricyclic-resistant patients, with a particular discussion of lithium augmentation. The major inadequacies of these studies have been the frequent lack of definitions of treatment resistance, the heterogeneity of the depressed samples, and the infrequent use of double-blind, placebo-controlled designs. Two central issues, definition of treatment resistance and clinical predictors of response to pharmacological treatments, are discussed in detail. Finally, a suggested guideline for the management of tricyclic-resistant depression is proposed.
自20世纪50年代末以来，尽管已引入了多种抗抑郁药物，但约30%-50%的抑郁症患者对这些药物无反应。针对难治性抑郁症，已提出了多种药物和非药物治疗策略。本文批判性地综述了针对三环类药物抵抗患者的单一和联合药物治疗研究，特别讨论了锂盐增效治疗。这些研究的主要不足在于，常常缺乏对抗抑郁药抵抗的定义，抑郁症样本的异质性，以及很少使用双盲、安慰剂对照设计。本文详细讨论了两个核心问题，即抗抑郁药抵抗的定义和药物治疗反应的临床预测因素。最后，提出了一份关于三环类药物抵抗性抑郁症治疗管理的建议指南。
