Pharmacologic approaches to treatment resistant depression: a re-examination for the modern era.
Pharmacologic approaches to treatment resistant depression: a re-examination for the modern era.
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DOI：
10.1517/14656561003614781
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发表时间：
2010-04
影响因子：
3.2
通讯作者：
Price LH
中科院分区：
文献类型：
--
作者：
Philip NS;Carpenter LL;Tyrka AR;Price LH
难治性抑郁症（TRD）是一种常见且令人衰弱的疾病。初始治疗通常不足以在给定的抑郁发作中实现完全缓解，导致更频繁的发作，严重程度恶化和严重残疾。本文综述了文献的诊断和药物治疗TRD的最新进展。关于常用的治疗方案的证据进行了严格的审查，并提供了关键建议。审查结束时，考虑药物作用于褪黑激素，乙酰胆碱，谷氨酸系统，有望作为未来的选择TRD。最近的趋势和研究结果影响了如何评估支持不同TRD方法的证据。例如，许多早期的TRD研究采用三环类药物（TCAs）作为主要抗抑郁药，但在常规临床实践中，TCAs现已被选择性5-羟色胺再摄取抑制剂（SSRIs）取代。缓解抑郁症的序贯治疗替代方案（星星 *D）研究解决了这一缺陷，该研究是迄今为止进行的最大的TRD有效性研究。然而，星星 *D研究的设计特征排除了与早期研究的简单比较。大多数TRD治疗建议的一个缺点是它们依赖于旧的研究，这些研究没有反映SSRIs在临床实践中的当前优势。这扭曲了TRD药理学策略的优先顺序。为了更好地反映当前的实践趋势，需要通过有效性研究来纠正这种扭曲，这需要对这种方法的优势和局限性进行批判性的考虑。
Treatment-resistant depression (TRD) is common and debilitating. Initial treatment is often insufficient to achieve full remission in a given depressive episode, resulting in more frequent episodes, worsened severity, and major disability. This review surveys literature on the diagnosis and pharmacological management of TRD in light of recent developments. Evidence regarding commonly used treatment options is critically examined and key recommendations are offered. The review ends by considering drugs acting on the melatonin, acetylcholine, and glutamate systems that hold promise as future options for TRD. Recent trends and research findings have impacted how the evidence supporting different approaches to TRD should be evaluated. For example, many earlier TRD studies employed tricyclics (TCAs) as the primary antidepressant, but TCAs have now been superseded by selective serotonin reuptake inhibitors (SSRIs) in routine clinical practice. This deficiency has been addressed by the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, the largest effectiveness study of TRD ever conducted. However, design characteristics of the STAR*D study preclude simple comparisons with earlier studies. A shortcoming of most treatment recommendations for TRD is their reliance on older studies that do not reflect the current preeminence of SSRIs in clinical practice. This has distorted the prioritization of pharmacological strategies for TRD. Efforts to correct this distortion with effectiveness research, designed to better reflect current practice trends, require critical consideration of the strengths and limitations of this approach.
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影响因子：
3.3
作者：
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