Patten S B, Love E J
Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Alberta, Canada.
Drug Saf. 1994 Mar;10(3):203-19. doi: 10.2165/00002018-199410030-00003.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R), drug-induced depression may be classified as an Organic Mood Syndrome, Depressed Type. Unfortunately, the DSM-III-R diagnostic criteria are not sufficiently precise for application in research, and studies of drug-induced depression have rarely utilised these criteria. Research concerned with drug-induced depression is characterised by a number of methodological complications. These include differing definitions of depression, including depression defined as a symptom, a syndrome, or by diagnostic criteria for a specific mental disorder. In addition, patients undergoing pharmacological treatments for medical illnesses are typically exposed to considerable psychosocial stress due to the suffering and disability associated with illness. These psychosocial factors may in themselves precipitate episodes of depression. Due to these complicating factors, sophisticated study designs are required to confirm an aetiological role for medications as risk factors for depression. Unfortunately, adequate studies have rarely been conducted, and much of the literature consists of case reports and clinical observations. Consequently, clinicians are frequently required to make clinical judgements about the aetiology of patients' depressive symptoms in the absence of definitive scientific information about the role of drugs. Nevertheless, a knowledge of the relevant literature will assist clinicians in making reasoned judgements about the aetiology, prevention and management of these disorders.
根据《精神疾病诊断与统计手册》（第三版修订本，DSM - III - R），药物性抑郁可归类为器质性心境综合征，抑郁型。遗憾的是，DSM - III - R的诊断标准在研究中的应用不够精确，且关于药物性抑郁的研究很少采用这些标准。与药物性抑郁相关的研究存在一些方法学上的复杂问题。这些问题包括对抑郁的定义不同，抑郁可被定义为一种症状、一种综合征，或依据特定精神障碍的诊断标准来定义。此外，因疾病接受药物治疗的患者通常会因疾病带来的痛苦和残疾而承受相当大的心理社会压力。这些心理社会因素本身可能会引发抑郁发作。由于这些复杂因素，需要采用精密的研究设计来证实药物作为抑郁风险因素的病因学作用。遗憾的是，很少进行充分的研究，且大部分文献都是病例报告和临床观察。因此，在缺乏关于药物作用的确切科学信息的情况下，临床医生经常需要对患者抑郁症状的病因做出临床判断。尽管如此，了解相关文献将有助于临床医生对这些疾病的病因、预防和管理做出合理判断。
