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难治性抑郁症优化治疗方案的研究
引用本文:李静,许秀峰,王刚,高成阁,赵靖平,唐牟尼,王丹,张波,孙学礼.难治性抑郁症优化治疗方案的研究[J].中华精神科杂志,2009,42(1).
作者姓名:李静  许秀峰  王刚  高成阁  赵靖平  唐牟尼  王丹  张波  孙学礼
作者单位:1. 四川大学华西医院心理卫生中心,成都,610041
2. 昆明医学院第一附属医院精神科
3. 首都医科大学附属北京安定医院
4. 西安交通大学附属第一医院精神科
5. 中南大学湘雅二医院精神卫生研究所
6. 广州市精神病院精神科
摘    要:目的 探讨难治性抑郁症的优化治疗方案.方法 对1128例抑郁症患者根据随机数字表随机接受三环类抗抑郁药、选择性5-羟色胺再摄取抑制剂及选择性5-羟色胺和去甲肾上腺素再摄取抑制剂治疗,每种药物的疗程均为6周;治疗中经上述1种药物治疗无效者随机换用上述另外两类药中的1种,继续治疗6周;仍无效且药物依从性好者构成难治性抑郁症则进入优化治疗方案(分别合用锂盐、甲状腺素、改良电休克、第二代抗精神病药及认知行为治疗等).1128例中非难治性抑郁症患者(非难治性抑郁症组)987例,难治性抑郁症患者(难治性抑郁症组)141例.于基线和治疗第1,2,4,6周末采用17项汉密尔顿抑郁量表(HAMD17)评定疗效.结果 治疗第6周末,非难治性抑郁症组总有效率为73.86%,难治性抑郁症组为58.87%,差异有统计学意义(P<0.01).难治性抑郁症组分别合并使用锂盐(54.3%)、甲状腺素(57.9%)、改良电休克(57.1%)、第二代抗精神病药(62.5%)及认知行为治疗(63.6%)等优化方案的总体有效率的差异无统计学意义(P>0.05).结论 合并优化方案治疗可提高超过50%的难治性抑郁症患者的疗效.

关 键 词:抑郁症  临床方案  抗抑郁药  抗精神病药  认知疗法  电惊厥疗法  优化治疗

Exploratory study of optimal treatment plan for treatment-resistant depression
LI Jing,XU Xiu-feng,WANG Gang,GAO Cheng-ge,ZHAO Jing-ping,TANG Mo-ni,WANG Dan,ZHANG Bo,SUN Xue-li.Exploratory study of optimal treatment plan for treatment-resistant depression[J].Chinese Journal of Psychiatry,2009,42(1).
Authors:LI Jing  XU Xiu-feng  WANG Gang  GAO Cheng-ge  ZHAO Jing-ping  TANG Mo-ni  WANG Dan  ZHANG Bo  SUN Xue-li
Abstract:Objective To explore the optimal treatment plan for treatment- resistant depression (TRD). Methods Patients who meet the inclusion and exclusion criteria were treated with different antidepressants randomly. Before the treatment, at the 1 st, 2nd, 4th, 6th week after treatment, the efficacy was evaluated with the 17-item Hamilton Rating Scale for Depression (HAMD). Results A total of 1128 subjects were enrolled, including 987 patients of non-TRD and 141 patients of TRD. At 2nd, 4th, 6th week, the HAMD scores were higher in TRD group. At 6th week after treatment, the total rates of response were 73.86% in non-TRD and 58.87% in TRD group respectively. The rates of response were 54.3%, 57.9%, 57.1%, 62.5%, 63.6% respectively in TRD patients with augmentation treatment of lithium, thyroxine, electro-convulsive treatment, atypical antipsychotics and cognitive behavioral therapy. Conclusion The treatment of antidepressant combined with lithium, thyroxine, electro-convulsive treatment, atypical antipsychotics or cognitive behavioral therapy can improve the efficacy in TRD patients.
Keywords:Depressive disorder  Clinical protocols  Antidepressive agents  Antipsychotic agents  Cognitive therapy  Electroconvulsive therapy  Optimal treatment
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