Schneider L S, Olin J T
Department of Psychiatry and Behavioral Sciences, University of Southern California School of Medicine, Los Angeles, USA.
Int Psychogeriatr. 1995;7 Suppl:7-25. doi: 10.1017/s1041610295002328.
The antidepressant literature for depression in late life tends to be interpreted as saying that certain antidepressant medications--e.g, nortriptyline, doxepin, fluoxetine--have fewer and milder side effects than others, whereas overall efficacy is equivalent (Plotkin et al., 1987; Rush, 1993; Salzman et al., 1995; Schneider, 1994). Further examination of this literature, however, suggests that both efficacy and side effect rates for any particular medication vary among trials, and often depend on the medications being compared, the use of placebo, the dose, and the design of the trial. In this report we review selected clinical trials, and summarize and discuss a previously published meta-analysis. Treatment recommendations from the 1991 NIH Consensus Development Conference on the Diagnosis and Treatment of Depression in Late Life and from the Agency for Health Care Policy Research are discussed. Directions for future research are suggested. Both antidepressant medications and brief structured psychotherapies have efficacy in the acute treatment of elderly depressed outpatients with major unipolar, nondelusional depression. Effective treatment for depression involves consideration of the type and severity of illness, adequate prescribing, patient education, and regular patient monitoring for compliance, symptom change, side effects, and intercurrent medical disorders, which may complicate antidepressant therapy.
针对老年期抑郁症的抗抑郁药文献往往被解读为某些抗抑郁药物——例如去甲替林、多塞平、氟西汀——比其他药物的副作用更少、更轻微，而总体疗效相当（普洛特金等人，1987年；拉什，1993年；萨尔兹曼等人，1995年；施奈德，1994年）。然而，对该文献的进一步研究表明，任何一种特定药物的疗效和副作用发生率在不同试验中存在差异，并且通常取决于所比较的药物、安慰剂的使用、剂量以及试验设计。在本报告中，我们回顾了一些选定的临床试验，并总结和讨论了一篇先前发表的荟萃分析。讨论了1991年美国国立卫生研究院关于老年期抑郁症诊断和治疗的共识发展会议以及医疗保健政策研究机构的治疗建议。提出了未来研究的方向。抗抑郁药物和简短的结构化心理治疗在治疗患有重度单相、非妄想性抑郁症的老年门诊抑郁症患者方面均有疗效。有效的抑郁症治疗需要考虑疾病的类型和严重程度、适当的开药、患者教育以及定期对患者进行监测，以确保其依从性、症状变化、副作用以及可能使抗抑郁治疗复杂化的并发内科疾病。
