Opportunities for Improving Access to Evidence-Based Treatments of Depression.
Opportunities for Improving Access to Evidence-Based Treatments of Depression.
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改善抑郁症循证治疗的机会。
DOI：
10.1176/appi.ajp.2019.19010098
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
Olfson,Mark
中科院分区：
文献类型：
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作者：
Weissman,MyrnaM;Wainberg,MiltonL;Olfson,Mark
抑郁症通常在青春期或成年早期发作。复发是常见的，并导致其严重残疾。轻度症状可能是新发作的开始，也可能是部分缓解发作的后遗症。等待症状完全爆发或留下轻度症状不治疗可能会错过改善患者预后的机会。了解未经治疗的抑郁症的自然过程，以及了解临床研究与实践之间的差异，有助于将研究结果转化为有效的临床护理。备受尊敬的研究人员Pim Cuijpers最近在《美国医学会杂志》上发表的观点低估了抑郁症治疗的有效性（1）。虽然作者承认严格的研究确定了抗抑郁药和一些心理疗法的疗效，但作者指出，大多数通过这些干预措施改善的患者在没有治疗的情况下就会康复，因此，大多数患者可能不需要治疗就能好转。他认为，应鼓励患者在开始积极治疗前等待，或尝试基于互联网或其他自助干预措施，这些干预措施不需要或只需要医疗保健专业人员提供最低限度的支持。
Depression usually has its onset during adolescence or early adulthood. Recurrences are common and contribute to its substantial disability. Mild symptoms may be the beginning of a new episode or lingering consequences of a partially remitted episode. Waiting for symptoms to become full blown or leaving mild symptoms untreated may miss opportunities to improve patient outcome. An understanding of the natural course of untreated depression, together with an appreciation of differences between clinical research and practice, facilitates translation of research findings into effective clinical care.A recent JAMA viewpoint by Pim Cuijpers, a highly respected researcher, undervalues the effectiveness of depression treatments (1). While acknowledging that rigorous studies establish efficacy of antidepressants and some psychotherapies, the author states that most patients who improve with these interventions would have recovered without treatment and that therefore treatment might not be necessary for most patients to get better. In his view, patients should be encouraged to wait before starting active treatment or try Internet-based or other self-help interventions that involve no or minimal support from health care professionals.