Frank E
Department of Psychiatry, University of Pittsburgh School of Medicine, PA 15213, USA.
J Clin Psychiatry. 1997;58 Suppl 1:11-4.
Barriers to patient adherence to antidepressant therapy include lack of knowledge in several important areas, including the nature of depression, the nature of treatments and how they can be expected to work, and the efficacy of pretreatment education. Other obstacles include unpleasant side effects of medications and negative attitudes and beliefs about medication on the part of patients and their families and treating physicians. Such barriers can be surmounted by approaches based on principles of good medical management, including: use of a multidisciplinary treatment team; education of patients and their families regarding the nature of depression and its treatments; the formation of an alliance among clinicians, patients, and family members; and the establishing of a clinic atmosphere that fosters such an alliance. Strategies to promote adherence should also address issues in practitioner disposition and training and barriers that arise as a result of the direct effects of depressive illness on the patient. In addition, such strategies must include measures appropriate to the different stages of depression treatment, including increased frequency of contact and intensity of support during acute treatment, regular monitoring during ongoing treatment, and the establishment of long-term relationships with those patients who have a history suggesting vulnerability to relapse.
患者坚持抗抑郁治疗的障碍包括在几个重要方面缺乏了解，包括抑郁症的本质、治疗方法的本质以及预期的治疗效果，以及治疗前教育的效果。其他障碍包括药物的不良副作用以及患者及其家属和治疗医生对药物的负面态度和看法。基于良好医疗管理原则的方法可以克服这些障碍，包括：使用多学科治疗团队；对患者及其家属进行关于抑郁症本质及其治疗方法的教育；在临床医生、患者和家庭成员之间建立联盟；营造促进这种联盟的诊所氛围。促进坚持治疗的策略还应解决从业者的态度和培训问题以及抑郁症直接影响患者所产生的障碍。此外，此类策略必须包括适合抑郁症治疗不同阶段的措施，包括在急性治疗期间增加接触频率和支持强度、在持续治疗期间进行定期监测，以及与有复发倾向病史的患者建立长期关系。
