Small G W
Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, School of Medicine, USA.
Depress Anxiety. 1998;8 Suppl 1:32-42.
The author reviews clinical issues regarding the treatment of late-life depression. Accurate diagnosis is complicated by the presence of medical illness, dementia syndromes, and heterogeneity of patient populations. Older depressed patients are often sensitive to drug toxicity resulting from age-related pharmacokinetic changes and polypharmacy. Thus, modification in the use of antidepressant drugs is needed to avoid side effects. Numerous antidepressant drugs are safe and efficacious in elderly depressed patients, and newer agents such as the selective serotonin reuptake inhibitors are often preferred over tricyclic antidepressants because of side effect profiles. Nonpharmacological approaches, alone and in combination with antidepressant drugs, are also useful, and maintenance treatments appear to reduce the likelihood of relapse.
作者回顾了关于老年抑郁症治疗的临床问题。由于存在躯体疾病、痴呆综合征以及患者群体的异质性，准确诊断变得复杂。老年抑郁症患者往往对因年龄相关的药代动力学变化和联合用药导致的药物毒性敏感。因此，需要调整抗抑郁药物的使用以避免副作用。许多抗抑郁药物在老年抑郁症患者中安全有效，由于副作用方面的原因，选择性5-羟色胺再摄取抑制剂等新型药物通常比三环类抗抑郁药更受青睐。非药物治疗方法单独使用或与抗抑郁药物联合使用也很有用，维持治疗似乎能降低复发的可能性。
