Hollister L E
Ann Intern Med. 1978 Jul;89(1):78-84. doi: 10.7326/0003-4819-89-1-78.
The multiple manifestations of depression may mimic those associated with many physical illnesses, leading to delay in diagnosis. The consequences of depression are disability, suffering, and sometimes death by suicide. Antidepressant drugs have greatly improved the prognosis for the depressed patient. Tricyclics are the drugs of first choice, with monoamine oxidase inhibitors playing a secondary role except in special instances. Drugs can be used along with electroconvulsive therapy when treatment is urgent. Differences in the pharmacologic effects of tricyclics may affect their choice for individual patients. Monitoring of plasma concentrations of tricyclics may uncover some sources of drug failure, such as altered drug kinetics in an individual patient or noncompliance with treatment. Side-effects of antidepressant drugs are numerous; most represent extensions of known pharmacologic actions. Overdoses produce severe intoxications that require expert and assiduous management.
抑郁症的多种表现可能与许多躯体疾病的表现相似，从而导致诊断延误。抑郁症的后果是残疾、痛苦，有时甚至是自杀死亡。抗抑郁药物极大地改善了抑郁症患者的预后。三环类药物是首选药物，单胺氧化酶抑制剂除特殊情况外起次要作用。在紧急治疗时，药物可与电休克疗法联合使用。三环类药物药理作用的差异可能会影响其对个体患者的选择。监测三环类药物的血浆浓度可能会发现一些药物治疗失败的原因，例如个体患者药物动力学改变或不依从治疗。抗抑郁药物的副作用很多；大多数是已知药理作用的延伸。过量用药会产生严重中毒，需要专业且细致的处理。
