抑郁症:对抗性和对治疗部分反应的管理
Heidi L Gaddey1, Brandyn Mason1, Amol Naik1
1Carle Foundation Hospital Family Medicine Residency, Urbana, Illinois.
American family physician
|May 28, 2024
概括
耐治疗抑郁症 (TRD) 影响许多患者,尽管有多种药物试验. 管理包括心理治疗,药物调整,或新的治疗方法,如胺,电疗法,和跨磁刺激.
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.
- 药理学 药理学是指药理学的学科.
背景情况:
- 耐治疗抑郁症 (TRD) 是一个重大的临床挑战,影响到31%的患有重度抑郁症的人.
- 尽管对至少两种抗抑郁药物进行了充分的试验,但TRD的特征是缺乏缓解.
- 部分反应,定义为不到50%的症状减少,需要在诊断TRD之前仔细确认坚持.
研究的目的:
- 概述目前治疗耐药抑郁症 (TRD) 的管理策略.
- 审查TRD的药理和非药理干预措施.
- 讨论新的治疗方法的作用和药物遗传学测试的局限性.
主要方法:
- 审查当前的临床指导方针和TRD管理的证据.
- 识别增强策略,包括药理和非药理选择.
- 评估新兴的治疗方法,如胺,胺,电疗法 (ECT) 和重复性跨磁刺激 (rTMS).
主要成果:
- 建议用第二代抗抑郁药,非典型抗精神病药,三环抗抑郁药,或triiodothyronine作为药理选择进行增强.
- 胺和胺显示TRD和减少自杀念头的潜力.
- 电疗法 (ECT) 和重复性跨磁刺激 (rTMS) 是有效的非药物干预措施.
- 药物遗传学测试目前缺乏足够的证据来进行常规的临床推.
结论:
- 有效的TRD管理涉及多模式方法,包括心理治疗,药物类别切换和增强.
- 新型药理学药物 (胺,胺) 和神经调节技术 (ECT,rTMS) 为耐药性抑郁症提供了有前途的替代方案.
- 在实施先进的TRD策略之前,确认药物坚持和剂量至关重要.
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