When at first you don't succeed: sequential strategies for antidepressant nonresponders.
When at first you don't succeed: sequential strategies for antidepressant nonresponders.
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发表时间：
1997-05
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通讯作者：
M. Thase;A. Rush
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作者：
M. Thase;A. Rush
现在，对于那些不能从标准的一线抗抑郁药物治疗中获益的抑郁症患者来说，比以往任何时候都有更多的选择。在本文中，替代抗抑郁药的战略审查的背景下，五个阶段的战略，范围从较小到较大程度的治疗阻力。建议的总体战略从简单的（即，替代的单一疗法）到更复杂的策略（即，联合或加强方案），非选择性单胺氧化酶抑制剂（+/-锂盐）和电休克疗法通常分别用于治疗III期和IV期耐药。心理治疗管理也是对这些患者进行持续治疗的重要组成部分，特别是为了抵消士气低落和沮丧，这是可以理解的，伴随着对如此多的治疗没有反应。
Now, more than ever before, a wealth of options exists for depressed patients who do not benefit from treatment with standard, first-line antidepressant agents. In this paper, alternate antidepressant strategies are reviewed within the context of a five-stage strategy, ranging from lesser to greater degrees of treatment resistance. The overall strategy recommended progresses from simpler (i.e., an alternate monotherapy) to more complex strategies (i.e., combination or augmentation regimens), with the nonselective monoamine oxidase inhibitors (+/- lithium salts) and electroconvulsive therapy typically reserved for treatment of Stages III and IV of resistance, respectively. Psychotherapeutic management also is an important ingredient in the ongoing treatment of these patients, particularly to counteract the demoralization and frustration that understandably accompany the failure to respond to so many treatments.