Occurrence and management of depression in the context of naltrexone treatment of alcoholism.
Occurrence and management of depression in the context of naltrexone treatment of alcoholism.
复制标题
纳曲酮治疗酒精中毒背景下抑郁症的发生和治疗。
DOI：
10.1176/ajp.156.8.1258
复制
发表时间：
1999
期刊：
影响因子：
--
通讯作者：
O'Malley,SS
中科院分区：
文献类型：
--
作者：
Farren,CK;O'Malley,SS
酒精依赖常常伴随着抑郁症的并存。随着酒精中毒的药物治疗变得越来越普遍，随着纳曲酮和氨基己酸酯等新药的出现，这些患者合并抑郁症的联合药物治疗问题将更加频繁地出现。过去，人们对抑郁症合并酒精依赖患者使用抗抑郁药物有重大担忧，研究并不总是支持这种治疗的有效性(1，2)。再加上治疗精神病学家的病因学重点是与酒精中毒相关的抑郁症是原发还是继发性的，基于酒精中毒是在抑郁症状之前还是之后，治疗医生相当不愿意积极地用药物治疗这种抑郁症，甚至是“原发”抑郁症。最近为区分与酗酒有关的情感症状所作的努力纳入了物质诱导型重度抑郁症(在使用或戒断药物的情况下发生)和非物质依赖型重度抑郁症(抑郁症要么发生在酗酒开始之前，要么发生在戒酒期间)的概念(3)。现在的研究表明，药物治疗与酒精中毒相关的抑郁症、继发性抑郁症和原发性抑郁症都有好处(4，5)。鉴于这些进展，以及酒精中毒的药物治疗方面的进展(6-8)，一些患者将不可避免地从两种治疗方法中受益：使用抗抑郁药物治疗抑郁症和管理酒精消费以及使用纳曲酮或氨基己酸酯治疗嗜酒。为了说明这些重要的临床和研究问题，并强调当前对原发抑郁症和继发性抑郁症的一些看法，以及最近提出的物质依赖型和物质非依赖型抑郁症的二分法(3)，我们提供以下来自耶鲁大学物质滥用治疗单位的案例。
Alcohol dependence frequently presents with comorbid depression. As pharmacological treatment for alcoholism becomes more common, with the advent of novel medications such as naltrexone and acamprosate, the issue of combined pharmacotherapy for comorbid depression in these patients will arise more frequently. There has been significant concern in the past about the use of antidepressant medication for depressed patients with comorbid alcohol dependence, and research has not always supported the efficacy of such treatment (1, 2). Coupled with the etiological focus of treating psychiatrists on whether the depression associated with alcoholism was primary or secondary, based on whether the alcoholism preceded or followed the depressive symptoms, there was considerable reluctance among treating physicians to aggressively medicate that depression, even “primary” depression. More recent efforts to distinguish among affective syndromes associated with alcoholism have incorporated the idea of substance-induced major depression (in which the depression occurs in the context of substance use or withdrawal) and substance-independent major depression (in which the depression either occurs before the onset of alcoholism or occurs during a period of abstinence from alcohol)(3). Research is now showing the benefits of pharmacologically treating the depression associated with alcoholism, secondary as well as primary (4, 5). Given these advances, as well as advances in pharmacological treatment of alcoholism (6–8), it is inevitable that some patients will benefit from two treatment approaches: management of depression with an antidepressant and management of alcohol consumption and craving with naltrexone or acamprosate. To illustrate these important clinical and research issues and to highlight some of the current thinking about primary versus secondary depression and the more recent proposed dichotomy of substance-dependent and substance-independent depression (3), we present the following case from the Substance Abuse Treatment Unit at Yale University.