Reynolds C F, Frank E, Perel J M, Mazumdar S, Kupfer D J
Mental Health Clinical Research Centers for the Study of Late-Life and Mid-Life Mood Disorders, Pittsburgh, Pennsylvania, USA.
Int Psychogeriatr. 1995;7 Suppl:27-39. doi: 10.1017/s104161029500233x.
Major depression in the elderly is often a relapsing, chronic illness with high risk for chronic invalidism, poor treatment compliance, and suicide. In most cases, maintenance treatment to prevent recurrence and to enhance the quality of life is thought to be indicated. We review recent data from our ongoing studies that support both the efficacy and the safety of pharmacotherapeutic and psychotherapeutic maintenance treatments. However, the challenges of conducting maintenance therapy research (particularly with a placebo control) with the elderly are many, involving such areas as recruitment, retention, compliance, choice of outcome measures, and informed consent. We discuss each of these challenges and our responses to them. Finally, we suggest that maintenance therapy trials should be extended in several directions: (a) long-term treatment of bipolar and delusional subtypes in the elderly, as well as depression associated with progressive neurodegenerative disorders such as Alzheimer's dementia; (b) assessment of the benefits and risks of long-term therapy with other than tricyclic and monoamine oxidase inhibitor antidepressant agents, such as selective serotonin reuptake inhibitors; and (c) development of models of long-term course, including the interaction of treatments with medical and psychosocial variables that can have a profound impact on illness onset and offset. These issues are illustrated with a discussion of a new protocol designed to test the acute and maintenance efficacy of antidepressant therapy for depressed patients with Alzheimer's disease.
老年人的重度抑郁症通常是一种复发性的慢性疾病，具有导致慢性残疾、治疗依从性差和自杀的高风险。在大多数情况下，人们认为需要进行维持治疗以预防复发并提高生活质量。我们回顾了我们正在进行的研究中的最新数据，这些数据支持药物治疗和心理治疗维持治疗的有效性和安全性。然而，对老年人进行维持治疗研究（尤其是采用安慰剂对照）面临诸多挑战，涉及招募、留用、依从性、结局指标的选择以及知情同意等领域。我们讨论了这些挑战以及我们对它们的应对措施。最后，我们建议维持治疗试验应在几个方向上进行扩展：(a) 对老年人双相和妄想亚型以及与阿尔茨海默病等进行性神经退行性疾病相关的抑郁症进行长期治疗；(b) 评估除三环类和单胺氧化酶抑制剂抗抑郁药之外的其他药物（如选择性5-羟色胺再摄取抑制剂）长期治疗的益处和风险；(c) 建立长期病程模型，包括治疗与可能对疾病发作和缓解产生深远影响的医学和心理社会变量之间的相互作用。通过讨论一项旨在测试抗抑郁治疗对阿尔茨海默病抑郁症患者的急性和维持疗效的新方案来说明这些问题。
