Joffe R T, Levitt A J, Sokolov S T
Regional Mood Disorders Program, Hamilton Psychiatric Hospital, Ontario, Canada.
J Clin Psychiatry. 1996;57 Suppl 7:25-31; discussion 32-3.
Approximately 20% to 40% of patients will fail to respond to the first antidepressant used for their current major depressive episode. Furthermore, it has been suggested that a further 20% to 30% of patients will have only a partial response. There are four main options to consider in the treatment of these patients: optimization, substitution, augmentation, and combination therapy. Several combination antidepressant treatments have been used in treatment-refractory depression. Moreover, various augmentation strategies have also proved to be successful. Although the empirical data to support these treatment options are limited, augmentation treatment has several potential advantages over the other clinical options available, particularly substitution. These data are reviewed and clinical applications discussed. Particular attention is paid to the role of anxiolytics as augmentation agents in the treatment of major depression.
约20%至40%的患者对用于其当前重度抑郁发作的第一种抗抑郁药无反应。此外，另有20%至30%的患者可能仅有部分反应。治疗这些患者主要有四种选择：优化治疗、换药、增效和联合治疗。几种联合抗抑郁治疗已用于难治性抑郁症。此外，各种增效策略也已证明是成功的。尽管支持这些治疗选择的实证数据有限，但与其他可用的临床选择相比，增效治疗有几个潜在优势，尤其是与换药相比。本文对这些数据进行了综述，并讨论了临床应用。特别关注了抗焦虑药作为增效剂在重度抑郁症治疗中的作用。
