Backing into the future: pharmacological approaches to the management of resistant depression.
Backing into the future: pharmacological approaches to the management of resistant depression.
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DOI：
10.1017/s003329171700068x
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发表时间：
2017-11
影响因子：
6.9
通讯作者：
Cowen PJ
中科院分区：
文献类型：
--
作者：
Cowen PJ
务实的研究表明，相当数量的抑郁症患者并没有缓解与目前的一线抗抑郁药治疗和两个失败的治疗步骤后，缓解与后续治疗的机会约为15%。本文重点介绍目前的证据，药物治疗难治性抑郁症以及可能的未来发展。对于两项抗抑郁药试验无效的患者，增加非典型抗精神病药物，特别是奎替鲁和阿立哌唑，有最好的疗效证据，尽管锂和三碘甲腺原氨酸等较老的治疗方法仍然有效。氯胺酮在难治性抑郁症中的显著抗抑郁作用刺激了对氯胺酮能化合物的研究;然而，用适合连续使用的药物来捕获氯胺酮的功效已被证明具有挑战性。炎症在抑郁症中的病理生理学作用的知识不断增长，为未来的治疗提供了很大的机会，从普通医学和治疗前分层的抑郁症患者中，这些干预措施可能是有益的抗炎药的再利用。最后，一种较老的药物，多巴胺受体激动剂普拉克索，如果谨慎使用，可能会很好地改善对目前方法无效的抑郁症患者的前景。
Pragmatic studies indicate that a substantial number of depressed patients do not remit with current first line antidepressant treatments and after two failed treatment steps the chance of remission with subsequent therapies is around 15%. This article focuses on current evidence for pharmacological treatments in resistant depression as well as possible future developments. For patients who have failed to respond to two antidepressant trials, augmentation with atypical antipsychotic drugs, specifically quetiapine and aripiprazole, has the best evidence for efficacy, though older treatments such as lithium and triiodothyronine still have utility. The striking antidepressant effect of ketamine in resistant depression has stimulated research into glutamatergic compounds; however capturing the efficacy of ketamine with drugs suitable for continuous use has proved challenging. Growing knowledge of the pathophysiological role of inflammation in depression offers great opportunities for future treatment in terms of repurposing anti-inflammatory agents from general medicine and pre-treatment stratification of those depressed patients in whom such interventions are likely to be beneficial. Finally an older drug, the dopamine receptor agonist pramipexole, if used carefully may well improve the prospects of depressed patients who are refractory to current approaches.