Kuzel R J
Dakota Clinic at West Acres, Fargo, ND 58103, USA.
J Fam Pract. 1996 Dec;43(6 Suppl):S45-53.
Depression and anxiety disorders are distinct illnesses that often coexist. Patients suffering from both disorders have more psychological, physical, and social impairment than do patients suffering from either illness alone. Mixed anxiety-depression is gaining recognition as a separate diagnosis and has been included in the International Classification of Diseases, 10th edition, and in the appendix of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Current treatment recommendations for comorbid depression and anxiety are based on clinical experience with the treatment of anxiety and depressive disorders when they occur independently. Tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), and selective serotonin reuptake inhibitors (SSRIs) have been shown to be effective for simultaneously occurring anxiety and depression, but the side-effect profiles of the MAOIs and TCAs limit their use for this condition. Benzodiazepines are useful for the acute treatment of anxiety symptoms and buspirone for chronic generalized anxiety, but neither agent is effective for the long-term treatment of depression. The recently available antidepressants nefazodone and venlafaxine may also be useful for this patient population. When possible, psychotherapy should be used in conjunction with pharmacotherapy to improve treatment outcomes.
抑郁症和焦虑症是两种不同但常共存的疾病。同时患有这两种疾病的患者，相较于仅患其中一种疾病的患者，在心理、身体和社交方面有更多的损伤。混合性焦虑抑郁障碍正逐渐被认可为一种独立的诊断，并已被纳入《国际疾病分类》第10版以及《精神疾病诊断与统计手册》第4版的附录中。目前针对共病性抑郁和焦虑的治疗建议是基于对焦虑症和抑郁症独立发作时的临床治疗经验。三环类抗抑郁药（TCAs）、单胺氧化酶抑制剂（MAOIs）和选择性5-羟色胺再摄取抑制剂（SSRIs）已被证明对同时出现的焦虑和抑郁有效，但MAOIs和TCAs的副作用限制了它们在此类病症中的应用。苯二氮䓬类药物对焦虑症状的急性治疗有用，丁螺环酮对慢性广泛性焦虑有用，但这两种药物对抑郁症的长期治疗均无效。最近可用的抗抑郁药奈法唑酮和文拉法辛对此类患者群体可能也有用。如有可能，心理治疗应与药物治疗联合使用以改善治疗效果。
