Alexopoulos G S
Department of Psychiatry, Cornell University Medical College, White Plains, NY, USA.
J Clin Psychiatry. 1996;57 Suppl 14:14-20.
Problems in diagnosing depression and unclear pharmacologic guidelines may reduce the use and efficacy of antidepressant treatment in depressed demented patients. Data from the few controlled studies involving patients with depression and dementia suggest that tricyclic antidepressants improved depressive symptomatology in more than 50% of patients. However, comparable improvement has been reported with placebo. Cognitive dysfunction in elderly patients with depression appears to alter tricyclic plasma concentration-efficacy relationships. Enlargement of lateral brain ventricles may be associated with poor response to tricyclics as well as altered plasma concentration-efficacy relationships. There is some evidence that nontricyclic antidepressants may be effective in demented patients with depression. An emerging pharmacology for cerebrovascular disease may have relevance in treating and preventing several geriatric depressive syndromes, but specific studies are needed.
抑郁症诊断方面的问题以及不明确的药理学指南可能会降低抗抑郁治疗在痴呆抑郁患者中的使用和疗效。少数涉及抑郁症和痴呆症患者的对照研究数据表明，三环类抗抑郁药使超过50%的患者抑郁症状得到改善。然而，安慰剂也有类似的改善报告。老年抑郁症患者的认知功能障碍似乎会改变三环类药物血浆浓度与疗效的关系。侧脑室扩大可能与对三环类药物反应不佳以及血浆浓度与疗效关系改变有关。有证据表明，非三环类抗抑郁药可能对痴呆抑郁患者有效。一种新兴的脑血管疾病药理学可能与治疗和预防几种老年抑郁综合征有关，但还需要具体研究。
