照會情境下內科共病之憂鬱症

Depression in Medical Setting and Consultation-Liaison Scenario

內科病人合併憂鬱症，是很常見的照會情境。但在內科情境中。，憂鬱症可能被低估或忽略。如果病人出現「心理症狀」，或有憂鬱症家族病史，就要注意憂鬱症的可能性。此外，必須注意憂鬱症之鑑別診斷，某些內科疾病或藥物，可能造成次發性憂鬱症。憂鬱症的治療方式，包含低強度心理社會治療、高強度心理治療、藥物治療或跨團隊治療。開立抗憂鬱藥時，需評估病人的用藥史、遵囑性。從最低有效劑量開始，並避免多重用藥。內科疾病對抗憂鬱藥的吸收、分佈、排泄、代謝可能有影響，且內科用藥與抗憂鬱藥之間可能會有的交互作用，需評估調整藥物劑量。某些抗憂鬱藥物可能惡化內科疾病，則應該避免使用。

Comorbidity with depression in medical setting is common in consultation-liaison scenario. However, depression is under-estimated or ignored in medical setting. If a medical patient exhibits psychological symptoms or family history of depression, the presence of depression should be noted. Besides, differential diagnosis should be made. Some medical diseases or medications may cause secondary depression. The managements of depression include low intensity psychosocial therapy, high intensty psychotherapy, pharmacotherapy and collaborative care. Before prescription of antidepressant, it is warranted to assess the medication history and compliance. Start with lowest effetive dose of antidepressant and polypharmacy should be avoided. Medical disease may influence the absorption, distribution, elimination and metabolism of antidepressant. Drug-drug interaction with antidepressant is also possible. The dose of medication and antidepressant should be adjusted accordingly. Some antidepressant may aggravate medical symptoms and should be avoided.