Pharmacological treatment of depression in older patients with chronic obstructive pulmonary disease: impact on the course of the disease and health outcomes.
Pharmacological treatment of depression in older patients with chronic obstructive pulmonary disease: impact on the course of the disease and health outcomes.
复制标题
老年慢性阻塞性肺病患者抑郁症的药物治疗：对病程和健康结果的影响。
DOI：
10.1007/s40266-014-0186-0
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发表时间：
2014
期刊：
影响因子：
2.8
通讯作者：
Alexopoulos,GS
中科院分区：
文献类型：
--
作者：
Yohannes,AM;Alexopoulos,GS
超过40%的老年慢性阻塞性肺疾病（COPD）患者患有临床上显著的抑郁症状，可能会干扰他们的日常活动。未经治疗的抑郁症可能会增加身体残疾，社会孤立，绝望和医疗保健利用。本文综述了抑郁对COPD病程的影响、抗抑郁药物治疗的疗效及其临床意义。从已发表的试验中，抗抑郁药在COPD患者中的疗效尚无定论。具体而言，没有明确的证据表明抗抑郁药可以缓解抑郁症或改善呼吸困难或COPD的生理指标。在抑郁的COPD患者中进行的选择性再摄取抑制剂（SSRI）和三轮抗抑郁药（TCA）研究都受到方法学缺陷的显著限制，包括样本量小、样本异质性和用于诊断和监测抑郁治疗的量表的变异性。出于这个原因，目前尚不清楚哪些SSRIs或TCA在治疗抑郁的COPD患者时应该受到青睐，以及合适的剂量和持续时间范围是什么。简单地向老年抑郁COPD患者提供抗抑郁药物不太可能改善他们的病情。对于抑郁的COPD患者，无论是否使用抗抑郁药物治疗，都应考虑有前景的治疗策略，如认知行为疗法和协作护理方法。需要进一步的研究，大型随机对照试验，以检查抗抑郁药在COPD患者中的疗效，并进行长期随访。
Over 40% older chronic obstructive pulmonary disease (COPD) patients suffer from clinically significant depressive symptoms that may interfere in their daily activities. Untreated depression may increase physical disability, social isolation, hopelessness and healthcare utilization. This review examined the impact of depression on the course of COPD, and the efficacy of antidepressant drugs therapy and their implication for clinical practice. The efficacy of antidepressants from the published trials in patients with COPD has been inconclusive. Specifically, there has been no clear evidence that antidepressants can induce remission of depression or ameliorate dyspnoea or physiological indices of COPD. Both the selective reuptake inhibitors (SSRI) and tricycle antidepressant (TCA) studies conducted in depressed COPD patients have been significantly limited by methodological weaknesses including low sample size, sample heterogeneity, and variability in scales used to diagnose and to monitor the treatment of depression. For this reason, it remains unclear whether which SSRIs or TCAs should be favoured in the treatment of depressed COPD patients and what is an appropriate dosage and duration range. Simply offering antidepressant drugs to older depressed COPD patients is unlikely to improve their conditions. Promising treatment strategies such as cognitive behavioural therapy and collaborative care approach should be considered with or without antidepressants drug therapy for depressed COPD patients. Further studies are needed with large randomised controlled trials to examine the efficacy of antidepressants in patients with COPD with long-term follow-up.