Major depressive disorder treatment guidelines in America and Europe.
Major depressive disorder treatment guidelines in America and Europe.
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DOI：
10.4088/jcp.9058se1c.04gry
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发表时间：
2010-01-01
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影响因子：
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通讯作者：
Davidson, Jonathan R T
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文献类型：
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作者：
Davidson, Jonathan R T
各种主要的美国和欧洲抑郁症治疗指南提供了类似的基本治疗原则，包括个性化治疗计划，为患者准备潜在的长期治疗，提供基于测量的护理，以及治疗缓解。虽然这些指南都是基于证据的，但某些因素可能会影响具体建议的差异，例如共识小组的组成、基本任务和文化态度。本文综述了近10年来欧洲和美洲发表的6套指南（美国精神病学协会、英国精神药理学协会、加拿大情绪和焦虑治疗网络、美国国家健康与临床优化研究所、德克萨斯药物算法项目和世界生物精神病学学会联合会）的异同。在指南中，轻度抑郁症在治疗建议中的差异最大;一些但不是所有的指南建议，它可以通过运动或观察等待来解决，但如果最初的努力失败，可以使用心理治疗或抗抑郁药。中度和重度抑郁症在指南中提出了大致相似的建议。中度重度抑郁症的一线治疗建议包括抗抑郁药单药治疗、心理治疗和两者联合治疗。重度抑郁症可能需要联合使用抗抑郁药和抗精神病药、电休克治疗或抗抑郁药和心理治疗。苯二氮卓类药物在抑郁症治疗中的作用非常有限;如果患者患有紧张性抑郁症、急性自杀性抑郁症或抑郁症伴焦虑、激越或失眠症状，一些指南建议苯二氮卓类药物仅用于短期治疗。
The various major American and European guidelines for the treatment of depression provide similar basic principles of treatment, which include individualizing the treatment plan, preparing the patient for potential long-term treatment, providing measurement-based care, and treating to remission. While the guidelines are all evidence-based, certain factors can influence differences in specific recommendations, such as the consensus group's composition, underlying mandates, and cultural attitudes. The similarities and differences among 6 sets of guidelines from Europe and the Americas published in the past decade are reviewed here (American Psychiatric Association, British Association for Psychopharmacology, Canadian Network for Mood and Anxiety Treatments, National Institute for Health and Clinical Excellence, Texas Medication Algorithm Project, and World Federation of Societies of Biological Psychiatry). In the guidelines, mild depression has the most variance in treatment recommendations; some, but not all, guidelines suggest that it may resolve with exercise or watchful waiting, but psychotherapy or antidepressants could be used if initial efforts fail. Moderate and severe major depression carry broadly similar recommendations among the guidelines. First-line treatment recommendations for moderate major depressive disorder include antidepressant monotherapy, psychotherapy, and the combination of both. Severe depression may require the combination of an antidepressant and an antipsychotic, electroconvulsive therapy, or the combination of an antidepressant and psychotherapy. Benzodiazepines play a very limited role in the treatment of depression; if the patient has catatonic depression, acutely suicidal depression, or depression with symptoms of anxiety, agitation, or insomnia, benzodiazepines are recommended by some guidelines for short-term treatment only.