Cadieux R J
Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, USA.
Am Fam Physician. 1998 Dec;58(9):2059-62.
Patients receiving antidepressant monotherapy may be partially or totally resistant to treatment in 10 to 30 percent of cases. In patients who have experienced only partial treatment results, the clinician should first consider optimizing antidepressant dosage or lengthening therapy. Antidepressant drug substitution should generally be reserved for use in patients who haven't responded at all (nonresponders). Combining two or more antidepressants is generally not recommended, as this approach may obscure adequate monotherapy evaluation and lead to significant adverse effects or drug-drug interactions. Use of electroconvulsive therapy is recommended in patients with psychotic and severe refractory depression. Augmentation therapy is often efficacious in patients who exhibit a partial antidepressant response. Lithium and thyroid hormone have been the most extensively studied augmentative agents but, more recently, pindolol and buspirone have also been used for this purpose.
接受抗抑郁药单一疗法的患者在10%至30%的病例中可能对治疗部分或完全耐药。对于仅取得部分治疗效果的患者，临床医生应首先考虑优化抗抑郁药剂量或延长治疗时间。抗抑郁药替代通常应留作完全没有反应（无反应者）的患者使用。一般不建议联合使用两种或更多种抗抑郁药，因为这种方法可能会掩盖充分的单一疗法评估，并导致显著的不良反应或药物相互作用。对于患有精神病性和严重难治性抑郁症的患者，建议使用电休克疗法。增效疗法对表现出部分抗抑郁反应的患者通常有效。锂盐和甲状腺激素是研究最广泛的增效剂，但最近，吲哚洛尔和丁螺环酮也已用于此目的。
