Treatment-resistant Depression

難治型憂鬱症

David L. Dunner

《台灣精神醫學》 27卷2期 (2013/06) Pp. 110-120+II

摘要

在這綜論一開始就提起「難治型憂鬱症」的定義議題。在文獻中，最常讀到的定義是「在足夠的抗憂鬱劑劑量及足夠的治療時間下，病人接受了兩種憂鬱劑活療，但是病人的憂鬱症狀還不會改善」。但是作者覺得這個定義不夠積極，而認為病人在第一次服用第一種抗憂鬱後，沒有達到理想的改善，醫師就要有心理準備，應開始懷疑病人可能是患有難治型憂鬱症。然後作者就開夠始介紹一群難治型患有憂鬱症的病人，使讀者有相當程度，對這群難治型憂鬱症病人有相當的認識。接著在此綜論最主要的章節內容中，作者不厭其煩的，介紹各種針對難治型憂鬱症的可能處理方法：包括更換不同類別的抗憂鬱劑，或是加上另外精神科或神經內科的藥劑，來加強抗憂鬱的治療效果；這些描述都有高品質的研究文獻來支持。然後作者也簡單的介紹非藥物療法，包括電氣痙攣療法、頭顱磁刺激療法、深腦部電流刺激療法，及針對認知功能性的心理治療等。最後針對難治型雙極性憂鬱期病人，作者也簡單的加以著墨。

關鍵字

難治型憂鬱症 ； 更換抗憂鬱劑 ； 加強抗憂鬱療法 ； STAR*D

並列摘要

This overview begins with the issue of definitions of treatment-resistant depression. From the most common definition of ”failure to respond to at least two treatment trials that were delivered at adequate dose and for an adequate duration of time,” the author has advanced the idea that treatment-resistant depression could be defined as a first treatment failure to one adequate treatment trial. The outcomes in patients with complicated treatment-resistant major depression are presented first. The major portion of this overview is devoted to the descriptions of various strategies from switching antidepressants to augmenting existing antidepressant with another psychotropic drug. Neuromodulating techniques (transcranial magnetic stimulation and Vagus nerve stimulation) as well as the issue of treatment resistant bipolar depression are also covered at the end of the overview.

並列關鍵字

treatment-resistance ； switching of antidepressant ； augmentation of antidepressant therapy ； STAR*D

參考文獻

Dunner, D.L.(2005).Treatment-resistant depression: an overview of the problem.Prim Psychiatry.12,8-11.

Rush, A.J.,Fava, M.,Wisniewski, S.R.(2004).Sequenced treatment alternatives to relieve depression (STAR*D): rationale and design.Control Clin Trials.1,119-42.

Edlich, R.F.(ed.),Spyker, D.A.(ed.)(1984).Current Emergency Therapy.Norwalk, Connecticut:Appleton-Century-Crofts.

Thase, M.E.,Rush, A.J.(1997).When at first you don't succeed: sequential strategies for anti-depressant nonresponders.J Clin Psychiatry.58(Suppl 13),23-29.

Dunner, D.L.,Rush, A.J.,Russell, J.M.,Woodward, S.,Wingard, P.,Allen, J.(2006).Prospective, long-term, multi-center study of the naturalistic outcomes of patients with treatment-resistant depression.J Clin Psychiatry.67,688-95.