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首页> 外文期刊>The journal of clinical psychiatry >What alternatives to first-line therapy for depression are effective?
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What alternatives to first-line therapy for depression are effective?

机译：一线治疗抑郁症的替代方法有效吗？

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Depression is often a chronic illness that requires a methodical, long-term approach to manage it optimally. A single antidepressant trial is often insufficient for patients to achieve remission. Remission rates for selective serotonin reuptake inhibitors are about 30% to 35%. Using successive treatment steps with optimal medication dosing and making measurement-based treatment decisions can help patients achieve remission, but, at each step, remission is less likely than at the first step. Depression is considered treatment-resistant if 2 adequate trials of medication fail. Clinicians can use validated symptom checklists such as the 16-Item Quick Inventory of Depressive Symptomatology, 9-Item Patient Health Questionnaire, Global Assessment of Functioning, and Sheehan Disability Scale to identify patients with treatment-resistant depression. Treatment resistance is likely in patients with a history of depressive chronicity and concurrent psychiatric and medical disorders and may be mistakenly suspected in patients who have had an inadequate trial of medication or who have been misdiagnosed. Strategies that can be effective to combat treatment resistance include optimizing treatment, switching to another antidepressant, combining antidepressants, and augmenting antidepressants with nonantidepressant treatments such as buspirone, lithium, liothyronine, atypical antipsychotics, or other agents. In addition, clinicians need to cultivate strong therapeutic alliances with patients, use objective measurements, practice evidence-based medicine, and educate patients about the disease and its treatments.
机译：抑郁症通常是一种慢性疾病，需要采取系统的长期措施来最佳地进行管理。一项抗抑郁试验通常不足以使患者获得缓解。选择性5-羟色胺再摄取抑制剂的缓解率约为30％至35％。使用具有最佳药物剂量的连续治疗步骤并制定基于测量的治疗决策可以帮助患者实现缓解，但是与第一步相比，在每个步骤中缓解的可能性均较小。如果有2次足够的药物治疗失败，抑郁症被认为是抗药性的。临床医生可以使用经过验证的症状清单，例如16项抑郁症症状快速调查表，9项患者健康问卷，功能总体评估和Sheehan残疾量表来识别患有抗药性抑郁症的患者。有慢性抑郁病史，并发精神病和内科疾病的患者可能会产生治疗抵抗力，而药物治疗试验不充分或被误诊的患者可能会被误认为是治疗抵抗力。可以有效对抗治疗抗性的策略包括优化治疗，改用另一种抗抑郁药，将抗抑郁药联合使用，以及用非抗抑郁药治疗（例如丁螺环酮，锂，碘甲状腺素，非典型抗精神病药或其他药物）增强抗抑郁药。此外，临床医生需要与患者建立强有力的治疗联盟，使用客观的测量方法，采用循证医学，并就此疾病及其治疗方法教育患者。

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