Drug Augmentation for Treatment-refractory Major Depressive Disorder

難治型重度憂鬱症之藥物強化治療

陳奕安(Cynthia Yi-An Chen) ； 邱一航(Yi-Hang Chiu) ； 沈武典(Winston W. Shen)

《台灣精神醫學》 32卷3期 (2018/09) Pp. 188-199+ii

摘要

Major depressive disorder (MDD) is one of the most frequent psychiatric diseases seen in the clinic. Most MDD patients can be treated reliably and comfortably with the use of one antidepressant. But some patients have treatment-refractory depression (TRD), which needs to be managed with switch of the antidepressant or augmentation therapy with another antidepressant or other drugs. Therefore, managing TRD is a challenge for practicing psychiatrists. In this overview, the authors are focusing on treating TRD with augmentation therapy. First, clinicians need to be well-versed in behavioral and physiological classification of antidepressants as a logical basis of choosing an appropriate antidepressant for add-on therapy. Second, clinicians need to be familiarized with data of clinical drug trials for treating TRD with second-generation antipsychotic drugs such as aripiprazole, olanzapine, and quetiapine, approved by the Food and Drug Administration (FDA) of the United States. Third, clinicians need to recognize the use of lithium and thyroid hormone as an add-on drugs for treating patients with TRD. Finally, the patients need to be educated to adapt a healthy lifestyle such as having the habit of regular aerobic exercise, refraining from substance uses, etc. With all those tips, the authors believe that the goal of remission can be more easily achieved for patients with TRD.

關鍵字

a second antidepressant ； second generation antipsychotic drugs ； lithium ； thyroid hormone

並列摘要

重度憂鬱症為門診最常見的精神科疾病之一。大多數的重度憂鬱症病人能藉由單一種抗憂鬱劑得到可靠並有效的治療。但有些病人屬於難治型憂鬱症，則需要接受藥物的轉換、合併另一種抗憂鬱劑或其他藥物的強化治療。因此，如何治療難治型憂鬱症的病人對於精神科醫師來說是一大挑戰。在本篇文章裡，作者主要聚焦在以強化治療的策略來治療難治型憂鬱症。首先，臨床醫師需要充分精通抗憂鬱劑的行為生理機轉分類，以作為選擇合適的抗憂鬱劑作為輔助治療的邏輯基礎。其次，臨床醫師應熟悉美國食品藥品監督管理局核准能作為難治型憂鬱症治療用藥，包括aripiprazole，olanzapine以及quetiapine等第二代抗精神病劑之臨床藥物研究。第三，臨床醫師應理解使用鋰鹽，做為治療難治型憂鬱症的輔助用藥。第四，甲狀腺賀爾蒙的收使用，做為治療難治型憂鬱症的輔助用藥。最後，病人必須被衛教以調整達到健康的生活方式，如養成規律的有氧運動習慣，戒除不當的物質使用等。藉由以上訣竅，作者相信難治型憂鬱症病人應能更容易達到緩解的目標。

並列關鍵字

第二種抗憂鬱劑 ； 第二代抗精神病劑 ； 鋰鹽 ； 甲狀腺賀爾蒙

參考文獻

Kessler RC, Berglund P, Demler O, et al.: The epidemiology of major depressive disorder results from the National Comorbidity Survey Replication (NCS-R). JAMA 2003; 289: 3095-105.

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Washington DC: American Psychiatric Association, 2013.

Shen WW: Antidepressant therapy. Aino Journal (Osaka) 2016: 15: 1-13.

Keller MB, Klerman GL, Lavori PW, et al.: Longterm outcome of episodes of major depression: clinical and public health significance. JAMA 1984; 252: 788-92.

Mojtabai R: Nonremission and time to remission among remitters in major depressive disorder: revisiting STAR*D. Depress Anxiety 2017; 34: 1123-33.