Kupfer D J
Department of Psychiatry, University of Pittsburgh School of Medicine, Pa.
J Clin Psychiatry. 1993 Feb;54 Suppl:29-33; discussion 34-5.
Research completed over the past decade has established the chronic and recurrent nature of major depression. To date, treatment for the prevention of recurrence has promoted the use of "maintenance" doses of antidepressant medications that are lower than the effective for the acute phase of treatment. Long-term randomized, double-blind studies of tricyclic antidepressant (TCA) maintenance therapy have shown, however, that full-dose treatment strategy has a highly significant prophylactic effect in preventing a new episode of depression for up to 5 years. Monthly interpersonal psychotherapy has also been shown to have a modest but significant effect on survival. Although prophylaxis with full-dose TCAs can be well tolerated by patients when proper education and support are provided, newer antidepressant agents with milder side effect profiles are being studied for their efficacy in long-term management of depression. The results of 1-year studies of maintenance therapy with serotonin selective reuptake inhibiting agents suggest that these medications will play a major role in prophylaxis for recurrent depression.
过去十年完成的研究已证实重度抑郁症具有慢性和复发性。迄今为止，预防复发的治疗方法一直提倡使用低于急性期治疗有效剂量的抗抑郁药物“维持”剂量。然而，三环类抗抑郁药（TCA）维持治疗的长期随机双盲研究表明，全剂量治疗策略在预防新的抑郁发作长达5年方面具有非常显著的预防效果。每月一次的人际心理治疗也已被证明对维持治疗有适度但显著的效果。虽然在提供适当教育和支持的情况下，患者对全剂量三环类抗抑郁药的预防治疗耐受性良好，但目前正在研究副作用较小的新型抗抑郁药在抑郁症长期管理中的疗效。对5-羟色胺选择性再摄取抑制剂维持治疗的1年研究结果表明，这些药物将在复发性抑郁症的预防中发挥主要作用。
