Callahan C M, Hendrie H C, Tierney W M
Indiana University School of Medicine, Regenstrief Institute for Health Care, USA.
Int J Psychiatry Med. 1996;26(2):155-71; discussion 173-5. doi: 10.2190/Q5YB-J2UW-LDAK-G1FX.
Efforts to improve the recognition and treatment of late-life depression in primary care are often based on the assumption that primary care physicians underutilize currently available and effective treatments. This article reviews the validity of this assumption and offers recommendations for future research.
Clinical trials designed to improve the recognition and treatment of late-life depression in primary care are reviewed. Because studies limited to older adults are rare, we also include studies enrolling younger patients. These data are reviewed in the context of recent reviews on the prevalence of depression in primary care settings and the effectiveness of available treatments.
Although depressive symptoms are common among older adults, there is insufficient literature documenting the proportion of these patients who respond to currently available treatments. Patients with uncomplicated major depressive disorder constitute the minority of primary care patients with depressive symptoms. Nearly all available studies of treatment effectiveness of pharmacotherapy or psychotherapy focus on older adults with uncomplicated major depression. Currently available treatment options may apply to less than 15 percent of depressed primary care patients.
More research is needed to help primary care providers manage their depressed patients with comorbid medical conditions, functional disability, or minor or chronic depressions. In addition, more research is needed to identify those patients who would benefit from specialized or interdisciplinary care.
在初级保健中改善对老年抑郁症的识别和治疗的努力通常基于这样一种假设，即初级保健医生未充分利用现有的有效治疗方法。本文回顾了这一假设的有效性，并为未来研究提供建议。
对旨在改善初级保健中对老年抑郁症的识别和治疗的临床试验进行了回顾。由于仅限于老年人的研究很少，我们还纳入了纳入年轻患者的研究。这些数据是在最近关于初级保健环境中抑郁症患病率和现有治疗方法有效性的综述背景下进行回顾的。
尽管抑郁症状在老年人中很常见，但文献中没有足够的资料记录这些患者中对现有治疗有反应的比例。单纯性重度抑郁症患者在有抑郁症状的初级保健患者中占少数。几乎所有关于药物治疗或心理治疗有效性的现有研究都集中在患有单纯性重度抑郁症的老年人身上。目前可用的治疗方案可能适用于不到15%的患有抑郁症的初级保健患者。
需要更多的研究来帮助初级保健提供者管理患有合并症、功能残疾或轻度或慢性抑郁症的抑郁症患者。此外，还需要更多的研究来确定那些将从专门或跨学科护理中受益的患者。
