緩和療護病人之憂鬱症藥物治療

Pharmacotherapy for Depression in Palliative Care

陳立奇(Lih-Chi Chen)

《北市醫學雜誌》 17卷4期 (2020/12) Pp. 402-411

https://doi.org/10.6200/TCMJ.202012_17(4).0005

摘要

憂鬱症是緩和療護病人常見的心理健康問題，影響病人及其照護家屬之生活品質。若心理支持性療法等非藥物治療無法改善病人精神心理症狀時，則必須適時給予合適的抗憂鬱藥物治療。現行臨床常用之抗憂鬱藥物類別包括：精神興奮劑、三環類抗憂鬱劑、選擇性血清素再回收抑制劑、血清素與正腎上腺素再回收抑制劑、及非典型抗憂鬱藥等，目前有關緩和療護抗憂鬱藥物之隨機雙盲臨床試驗不多，尚無證據可以支持那一類抗憂鬱藥最適於重症末期緩和療護病人使用。臨床使用藥物之選擇，需考量病人是否有其他合併症，以及藥物之療效起始、半衰期及效果維持時間、副作用、潛在的交互作用問題等，起始治療時需緩慢調整劑量謹慎用藥，以確保藥物療效及安全性。

關鍵字

緩和療護 ； 憂鬱症 ； 藥物治療

並列摘要

Depression is a common mental health problem among patients in palliative care, affecting the quality of life of the patients and their caregivers. Appropriate antidepressant medications should be given at the appropriate time when non-pharmacological treatments such as psychological supportive therapy cannot improve patient's mental and psychological symptoms. Current anti-depressant drugs commonly used in clinical practice include psychostimulants, tricyclic antidepressants, selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, and atypical antidepressants. There are few randomized double-blind clinical trials which examined the effectiveness of antidepressants in palliative care patients and no evidence was found to support that particular type of antidepressants are best for advanced-terminally ill patients. The choice of antidepressants would need to consider patient's comorbidities as well as the initial treatment effects, half-life and effective period, side effects, potential interaction problems, etc. The dosage during initial treatment should be adjusted gradually to ensure the efficacy and safety of drug therapy.

並列關鍵字

palliative care ； depression ； pharmacotherapy