治疗耐药抑郁症的下一步治疗选择:来自梅奥诊所抑郁症中心小组的见解
Matheus G Marques1, Aysegul Özerdem1, Simon Kung1
1Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota.
The Journal of clinical psychiatry
|January 28, 2026
概括
耐治疗抑郁症 (TRD) 缺乏明确的定义,使护理复杂化. 专家的共识建议增加抗精神病药物,TMS或胺,根据标准指南之外的患者因素量身定制.
科学领域:
- 精神病学是一个精神病学.
- 临床神经科学 临床神经科学
- 药理学 药理学是指药理学的学科.
背景情况:
- 耐治疗性抑郁症 (TRD) 影响了相当一部分主要抑郁症患者,增加了发病率和自杀风险.
- 对TRD缺乏标准化的定义使治疗选择和优先考虑变得复杂.
- 现有的指导方针提供了广泛的治疗类别,在新的干预措施和复杂的临床情景中存在持续的证据差距.
研究的目的:
- 通过建模修改的Delphi共识,提供对TRD治疗选择的临床视角.
- 解决TRD标准化定义和治疗优先级的差距.
- 探索有关TRD下一步治疗策略的专家意见.
主要方法:
- 一个基于案例的模拟讨论,涉及10名在梅奥诊所抑郁症中心专门从事TRD治疗的精神病医生.
- 在三次失败的抗抑郁药试验后,使用TRD患者的结构化临床细节对下一步治疗选择进行代排名.
- 三轮匿名调查,中间有小组讨论,包括六种反映代谢疾病和年龄等临床考虑的图片变化.
主要成果:
- 强烈的共识支持使用第二代抗精神病药物,跨磁刺激 (TMS) 和胺/胺作为TRD的初始下一步治疗.
- 根据患者特征调整治疗偏好,包括非增强型抗抑郁药和电疗法 (ECT).
- 专家意见强调,需要将TRD战略定制到超越传统的指导层.
结论:
- 将TRD的治疗策略与个体患者的因素相适应,对于有效的护理至关重要.
- 整合多学科观点和患者偏好可以提高TRD的治疗选择.
- 这种专家共识为治疗耐药抑郁症的个性化护理提供了宝贵的见解.
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