Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
Department of Psychiatry, Semel Institute for Neuroscience, University of California Los Angeles, Los Angeles, CA, USA.
Psychiatr Clin North Am. 2023 Jun;46(2):371-389. doi: 10.1016/j.psc.2023.02.008. Epub 2023 Mar 27.
Major depression is common in older adults (≥ 60 years of age), termed late-life depression (LLD). Up to 30% of these patients will have treatment-resistant late-life depression (TRLLD), defined as depression that persists despite two adequate antidepressant trials. TRLLD is challenging for clinicians, given several etiological factors (eg, neurocognitive conditions, medical comorbidities, anxiety, and sleep disruption). Proper assessment and management is critical, as individuals with TRLLD often present in medical settings and suffer from cognitive decline and other marks of accelerated aging. This article serves as an evidence-based guide for medical practitioners who encounter TRLLD in their practice.
老年期抑郁症（≥60 岁）较为常见，被称为老年期迟发性抑郁症（LLD）。这些患者中高达 30%的人会患有治疗抵抗性老年期迟发性抑郁症（TRLLD），其定义为尽管进行了两次充分的抗抑郁药试验，但抑郁仍持续存在。鉴于多种病因因素（例如，神经认知状况、合并医学疾病、焦虑和睡眠障碍），TRLLD 给临床医生带来了挑战。适当的评估和管理至关重要，因为 TRLLD 患者通常在医疗环境中就诊，并遭受认知能力下降和其他加速衰老的迹象。本文为在实践中遇到 TRLLD 的医疗从业者提供了循证指南。
