Evaluating antidepressant therapies: remission as the optimal outcome.
Evaluating antidepressant therapies: remission as the optimal outcome.
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发表时间：
2003-10
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通讯作者：
M. Thase
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作者：
M. Thase
抑郁症是全球疾病负担的第四大贡献者，它给医疗保健系统和社会带来了巨大的痛苦和巨大的成本。虽然有许多新的抗抑郁药被引入，但很少有抑郁症患者得到最佳治疗。一个问题是抗抑郁治疗反应的传统定义，即，50%的症状改善，确保除了症状强度的降低之外几乎没有什么。有持续抑郁症状的应答者经历持续的心理社会功能障碍，健康状况较差，复发风险增加。第一次或急性期治疗的目标应该是症状完全缓解，功能完全恢复到病前水平。缓解也是走向持续恢复的必要的过渡状态。在这种情况下，有关各种治疗方法的证据进行重新审查，考虑到关键的方法学问题，如设计敏感性和统计能力。尽管个别研究的结果不一致，但荟萃分析的结果（即，定量和汇总）表明，心理治疗-药物治疗组合和使用增强肾上腺素能和去甲肾上腺素能神经传递的抗抑郁药都增加了缓解的可能性。
Depression is the fourth-largest contributor to the global burden of disease, and it causes profound suffering and extreme costs to health care systems and society. Although there have been many new antidepressants introduced, few depressed individuals receive the optimal treatment. One problem is that the traditional definition of response to antidepressant therapy, i.e., a 50% improvement in symptoms, ensures little beyond a reduction of syndromal intensity. Responders who have persistent depressive symptoms experience ongoing psychosocial dysfunction, poorer health, and an increased risk of relapse. The goal of the first or acute-phase treatment should be complete remission of symptoms and a full return to premorbid levels of functioning. Remission is also a necessary, transitional state toward sustained recovery. Within this context, evidence pertaining to various treatment approaches is reexamined, taking into account critical methodological issues such as design sensitivity and statistical power. Whereas results of individual studies are inconsistent, the findings of meta-analyses (i.e., quantitative and pooled) suggest that both psychotherapy-pharmacotherapy combinations and use of antidepressants that enhance serotonergic and noradrenergic neurotransmission increase the likelihood of remission.