Wang Gang, Han Changsu, Liu Chia-Yih, Chan Sandra, Kato Tadafumi, Tan Wilson, Zhang Lili, Feng Yu, Ng Chee H
The National Clinical Research Center for Mental Disorder & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China.
Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, People's Republic of China.
Neuropsychiatr Dis Treat. 2020 Dec 3;16:2943-2959. doi: 10.2147/NDT.S264813. eCollection 2020.
Consensus is lacking on the management of treatment-resistant depression (TRD), resulting in significant variations on how TRD patients are being managed in real-world practice. A survey explored how clinicians managed TRD across Asia, followed by an expert panel that interpreted the survey results and provided recommendations on how TRD could be managed in real-world clinical settings.
Between March and July 2018, 246 clinicians from Hong Kong, Japan, Mainland China, South Korea, and Taiwan completed a survey related to their treatment approaches for TRD.
The survey showed physicians using more polytherapy (71%) compared to maintaining patients on monotherapy (29%). The most commonly (23%) administered polytherapy involved antidepressant augmentation with antipsychotics that 19% of physicians also indicated as their most important approach for managing TRD. The highest number of physicians (34%) ranked switching to another class of antidepressants as their most important approach, while 16% and 9% chose antidepressant combinations and electroconvulsive therapy (ECT), respectively.
Taking into account the survey results, the expert panel made general recommendations on the management of TRD. TRD partial-responders to antidepressants should be considered for augmentation with second-generation antipsychotics. For non-responders, switching to another class of antidepressants ought to be considered. TRD patients achieving remission with acute treatment should consider continuing their antidepressants for at least another 6 months to prevent relapse. ECT is a treatment consideration for patients with severe depression or persistent symptoms despite multiple adequate trials of antidepressants. Physicians should also consider the response, tolerability and adherence to the current and previous antidepressants, the severity of symptoms, comorbidities, concomitant medications, preferences, and cost when choosing a TRD treatment approach for each individual patient.
对于难治性抑郁症（TRD）的管理缺乏共识，这导致在现实临床实践中对TRD患者的管理方式存在显著差异。一项调查探讨了亚洲临床医生如何管理TRD，随后由一个专家小组对调查结果进行解读，并就如何在现实临床环境中管理TRD提供建议。
2018年3月至7月期间，来自中国香港、日本、中国大陆、韩国和台湾的246名临床医生完成了一项关于他们对TRD治疗方法的调查。
调查显示，与维持患者单一疗法（29%）相比，医生使用联合疗法的比例更高（71%）。最常用的联合疗法（23%）是抗抑郁药与抗精神病药联用，19%的医生也表示这是他们管理TRD最重要的方法。选择换用另一类抗抑郁药作为最重要方法的医生人数最多（34%），而分别有16%和9%的医生选择抗抑郁药联合使用和电休克治疗（ECT）。
考虑到调查结果，专家小组对TRD的管理提出了一般性建议。对抗抑郁药部分反应的TRD患者应考虑联用第二代抗精神病药。对于无反应者，应考虑换用另一类抗抑郁药。急性治疗后达到缓解的TRD患者应考虑继续服用抗抑郁药至少6个月以预防复发。ECT是重度抑郁症患者或尽管多次充分试用抗抑郁药仍有持续症状患者的一种治疗选择。在为每位患者选择TRD治疗方法时，医生还应考虑当前和既往抗抑郁药的反应、耐受性和依从性、症状严重程度、合并症、伴随用药、患者偏好和费用。
