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首页> 外文期刊>The journal of clinical psychiatry >Why do you need to move beyond first-line therapy for major depression?
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Why do you need to move beyond first-line therapy for major depression?

机译：为什么您需要超越一线疗法治疗重度抑郁症？

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Primary care clinicians need to move beyond first-line therapy for major depression. While initial treatment is ineffective in about two-thirds of patients, patients who have not responded to such initial treatments can be managed effectively. The severity of depression is as high in primary care as in specialty care settings. The risk of depression is currently elevated because economic hardship, job insecurity, and low socioeconomic status increase the likelihood of depression and treatment resistance. Depression worsens outcomes for medical comorbidities, such as cardiac disease, chronic obstructive pulmonary disease, and diabetes mellitus, and it increases the risk of rehospitalization. When depression is treatment-resistant (generally defined as not responding to 2 courses of treatment of adequate dose and duration), morbidity and mortality are increased, quality of life and function are reduced, and long-term brain changes may occur. Opportunities for change in care are available. Screening for depression in primary care settings with staff-assisted support, adopting the concepts of the patient-centered medical home and stepped care, and using new treatment options such as atypical antipsychotics and other treatment modalities can improve outcomes for these patients. Now is the time to make these moves because new tools, systems, and treatments offer ways to help these patients.
机译：初级保健临床医生需要超越针对严重抑郁症的一线治疗。虽然大约三分之二的患者的初始治疗无效，但是可以有效地处理对此类初始治疗没有反应的患者。在初级保健中，抑郁症的严重程度与在专科保健中一样高。由于经济困难，工作不安全和社会经济地位低下，增加了患抑郁症和抵抗治疗的可能性，因此抑郁症的风险目前正在增加。抑郁症会恶化诸如心脏病，慢性阻塞性肺疾病和糖尿病等医学合并症的预后，并增加再次住院的风险。当抑郁症具有抗药性（通常定义为对足够剂量和持续时间的2个疗程无反应）时，发病率和死亡率增加，生活质量和功能下降，并且可能发生长期脑部改变。提供改变护理的机会。在工作人员协助下筛查初级保健机构中的抑郁症，采用以患者为中心的医疗之家和阶梯式护理的概念，并采用新的治疗选择，例如非典型抗精神病药和其他治疗方式，可以改善这些患者的预后。现在是采取这些行动的时候了，因为新的工具，系统和治疗方法可以为这些患者提供帮助。

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