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首页> 外文期刊>The Australian and New Zealand journal of psychiatry >Difficult-to-treat depression: A clinical and research roadmap for when remission is elusive
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Difficult-to-treat depression: A clinical and research roadmap for when remission is elusive

机译：难以治疗抑郁症：缓解时难以捉摸的临床和研究路线图

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Objectives: The report considers the pros and cons of the most commonly used conceptual model that forms the basis for most clinical practice guidelines for depression. This model promotes the attainment of sustained symptom remission as the treatment goal based on its well-established prognostic and functional importance. Sustained remission is very unlikely, however, after multiple treatment attempts. Our current model propels many clinicians to continue to change or add treatments despite little chance for remission or full functional restoration and despite the increasing risk of more adverse events from polypharmacy. An alternative 'difficult-to-treat depression' model is presented and considered. It accepts that the treatment aims for some depressed patients may shift to optimal symptom control rather than remission. When difficult-to-treat depression is suspected, the many treatable causes of persistent depression must be assessed and addressed (given the importance of remission when attainable) before difficult-to-treat depression can be ascribed. The clinical and research implications of the difficult-to-treat depression model are discussed. Conclusion: Suspected difficult-to-treat depression provides a practical basis for considering when to conduct a comprehensive evaluation. Once difficult-to-treat depression is confirmed, treatment may better focus on optimal disease management (symptom control and functional improvement).
机译：目的：该报告考虑了最常用的概念模型的优缺点，这些模型构成了大多数临床实践抑郁症的基础。该模型促进了持续症状缓解作为治疗目标的持续症状缓解，基于其成熟的预后和功能重要性。然而，在多次治疗尝试之后，持续缓解是不太可能的。尽管很少有机会缓解或全功能恢复，但我们目前的模型推动了许多临床医生，尽管有几乎没有机会，但尽管有几乎没有功能恢复，但尽管越来越严重来自多酚职业的不良事件的风险。呈现和考虑替代的“难以治疗的抑郁症”模型。它认为治疗旨在一些抑郁症患者可能会转向最佳的症状控制而不是缓解。当怀疑难以治疗难以治疗的抑制抑郁症的许多可治疗原因时讨论了难以治疗的抑郁模型的临床和研究。结论：疑似难以治疗的抑郁症提供了考虑何时进行全面评估的实际基础。一旦确认难以治疗的抑郁症，治疗可能会更好地关注最佳疾病管理（症状控制和功能改进）。

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