耐治疗抑郁症:定义,流行,检测,管理和调查干预措施
Roger S McIntyre1,2,3, Mohammad Alsuwaidan3, Bernhard T Baune4,5
1Brain and Cognition Discovery Foundation, Toronto, ON, Canada.
概括
耐治疗抑郁症 (TRD) 缺乏统一的定义,使研究和护理复杂化. 已建立的治疗方法包括胺,胺,TMS和ECT,辅助疗法显示出有前途.
科学领域:
- 神经科学是一个神经科学.
- 精神病学是一个精神病学.
- 临床药理学 临床药理学
背景情况:
- 耐治疗抑郁症 (TRD) 是一种普遍存在的疾病,对公共健康有重大影响.
- 缺乏对TRD的共识定义,阻碍了准确的流行率估计,风险因素识别和干预开发.
- 目前的定义,包括广泛采用的FDA / EMA标准,重点关注对两种或更多抗抑郁药物的不充分反应.
研究的目的:
- 审查目前治疗耐药抑郁症的现状,包括定义,患病率和管理策略.
- 突出缺乏标准化的TRD定义所带来的挑战.
- 总结TRD中各种药理和非药理干预措施的证据.
主要方法:
- 对定义和管理耐治疗抑郁症的研究进行文献综述.
- 对当前临床指南和监管机构 (FDA,EMA) 的定义进行分析.
- 对既有和新兴的TRD治疗方法的证据综合.
主要成果:
- 至少30%的抑郁症患者可能符合当前的TRD标准,显著的百分比是伪耐药.
- 静脉注射胺,鼻腔注射胺,重复性跨磁刺激 (TMS) 和电疗法 (ECT) 是已知的TRD治疗方法.
- 辅助治疗,如某些第二代抗精神病药物和 olanzapine-fluoxetine 组合,显示出有效性,而心理治疗在与抗抑郁药物结合时提供症状缓解.
结论:
- 缺乏TRD共识定义使临床实践和研究复杂化.
- 对于TRD存在几种有效的干预措施,包括药物治疗 (胺,乙胺),神经调节 (TMS,ECT) 和辅助治疗.
- 未来的研究应该集中在完善TRD定义和探索新的治疗途径,如数字治疗.
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