Nemeroff C B
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322-4990, USA.
Depress Anxiety. 1996;4(4):169-81. doi: 10.1002/(SICI)1520-6394(1996)4:4<169::AID-DA3>3.0.CO;2-A.
In the evaluation of treatment-resistant or treatment-refractory depression (TRD), true resistance to antidepressant therapy must be distinguished from inadequate dose, duration, or compliance with past antidepressant therapy. Reassessment of the diagnosis may reveal psychiatric comorbidity, the presence of depressive subtypes, or the possibility of a medical etiology. Management of TRD should consider patient-specific factors; drug therapy may be directed by depressive subtype or the presence of psychiatric comorbidity. Increasing the dose or duration of current antidepressant therapy is appropriate for patients who have received inadequate therapy in the past. Augmentation of tricyclic antidepressant (TCA) or selective serotonin reuptake inhibitor (SSRI) therapy with thyroid hormone (T3) or lithium has been shown to be effective in open and controlled trials. Efficacy of other strategies such as higher-dose antidepressant treatment, venlafaxine therapy, combined antidepressant therapy, electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), or augmentation with pindolol or buspirone has been less well established, but emerging data from open studies and case reports are encouraging.
在评估难治性或治疗抵抗性抑郁症（TRD）时，必须将真正对抗抑郁治疗的抵抗与过去抗抑郁治疗剂量不足、疗程不够或依从性差区分开来。重新评估诊断可能会发现精神科共病、抑郁亚型的存在或医学病因的可能性。TRD的管理应考虑患者的具体因素；药物治疗可根据抑郁亚型或精神科共病情况来指导。对于过去治疗不充分的患者，增加当前抗抑郁治疗的剂量或疗程是合适的。在开放试验和对照试验中，三环类抗抑郁药（TCA）或选择性5-羟色胺再摄取抑制剂（SSRI）联合甲状腺激素（T3）或锂治疗已显示有效。其他策略的疗效，如高剂量抗抑郁治疗、文拉法辛治疗、联合抗抑郁治疗、电休克治疗（ECT）、经颅磁刺激（TMS）或用吲哚洛尔或丁螺环酮增效，尚未得到充分证实，但来自开放研究和病例报告的新数据令人鼓舞。
