Rush A J, Prien R F
University of Texas Southwestern Medical Center, Dallas, USA.
Psychopharmacol Bull. 1995;31(1):7-20.
This paper examines the nature and types of information and syntheses relevant to the strategic and tactical decisions required in the treatment of depression with medication. Strategic decisions (What to do?) include determining what is wrong, defining treatment objectives, selecting the first treatment, deciding the next best treatment (should the first treatment fail), and deciding when to discontinue a successful treatment. Tactical decisions (How to do?) include determining where and by whom treatment is conducted, and the specific steps involved (e.g., dosing, frequency of visits, assessment of outcome, recognition and management of side effects, compliance, etc.) in the treatment as well as in the discontinuation of treatment (e.g., taper schedule, frequency of visits, etc.). The treatment of each patient is inherently an experimental single case study. Because individual patients differ, the most luxuriant data bases cannot fully address all strategic and tactical decisions with certainty. Thus, practitioners must apply general principles and group (nomothetic) data to individual patients. The relationship between research efforts and the information needed by clinicians is examined. Suggestions for developing and reporting more clinically relevant information from efficacy trials and other research are made.
本文探讨了与药物治疗抑郁症所需的战略和战术决策相关的信息性质、类型及综合情况。战略决策（做什么？）包括确定问题所在、明确治疗目标、选择初始治疗方法、决定若初始治疗失败后的次优治疗方法，以及决定何时停止成功的治疗。战术决策（如何做？）包括确定治疗的地点和实施者，以及治疗过程（如给药剂量、就诊频率、疗效评估、副作用的识别与管理、依从性等）和停药过程（如逐渐减量计划、就诊频率等）所涉及的具体步骤。对每位患者的治疗本质上都是一项实验性的单病例研究。由于个体患者存在差异，即便最丰富的数据库也无法确定地全面解决所有战略和战术决策。因此，从业者必须将一般原则和群体（法则性）数据应用于个体患者。本文还探讨了研究工作与临床医生所需信息之间的关系。文中针对从疗效试验和其他研究中开发并报告更具临床相关性信息提出了建议。
