難治型憂鬱症

Treatment-resistant Depression

在這綜論一開始就提起「難治型憂鬱症」的定義議題。在文獻中，最常讀到的定義是「在足夠的抗憂鬱劑劑量及足夠的治療時間下，病人接受了兩種憂鬱劑活療，但是病人的憂鬱症狀還不會改善」。但是作者覺得這個定義不夠積極，而認為病人在第一次服用第一種抗憂鬱後，沒有達到理想的改善，醫師就要有心理準備，應開始懷疑病人可能是患有難治型憂鬱症。然後作者就開夠始介紹一群難治型患有憂鬱症的病人，使讀者有相當程度，對這群難治型憂鬱症病人有相當的認識。接著在此綜論最主要的章節內容中，作者不厭其煩的，介紹各種針對難治型憂鬱症的可能處理方法：包括更換不同類別的抗憂鬱劑，或是加上另外精神科或神經內科的藥劑，來加強抗憂鬱的治療效果；這些描述都有高品質的研究文獻來支持。然後作者也簡單的介紹非藥物療法，包括電氣痙攣療法、頭顱磁刺激療法、深腦部電流刺激療法，及針對認知功能性的心理治療等。最後針對難治型雙極性憂鬱期病人，作者也簡單的加以著墨。

This overview begins with the issue of definitions of treatment-resistant depres- sion. From the most common definition of “failure to respond to at least two treat- ment trials that were delivered at adequate dose and for an adequate duration of time,” the author has advanced the idea that treatment-resistant depression could be defined as a first treatment failure to one adequate treatment trial. The outcomes in patients with complicated treatment-resistant major depression are presented first. The major portion of this overview is devoted to the descriptions of various strate- gies from switching antidepressants to augmenting existing antidepressant with an- other psychotropic drug. Neuromodulating techniques (transcranial magnetic stimu- lation and Vagus nerve stimulation) as well as the issue of treatment resistant bipolar depression are also covered at the end of the overview.