抗抑郁药治疗抑郁症前后脑影像学的改变及对疗效预测的研究进展

磁共振成像为抑郁症患者对于不同机制抗抑郁药物治疗抑郁症时的脑结构及脑功能改变提供了重要的影像学证据,也是预测不同机制抗抑郁药物治疗抑郁症临床疗效的重要手段。本文对国内外不同机制的抗抑郁药物治疗抑郁症时,头颅磁共振影像学的变化进行综述,并再对国内外头颅磁共振对抗抑郁药治疗抑郁症时疗效的预测研究进行综述。     

96例老年抑郁症用药的调查分析

抗抑郁药物是治疗抑郁症的有效方法,但目前抗抑郁药物对老年抑郁症治疗报导甚少。为此,我们对本中心1996年7月至1997年6月间符合CCMD-2-R抑郁症诊断标准的97例住院老年抑郁症病人的抗抑郁药物治疗进行分析,现报导如下。     

抗抑郁药联合治疗之前应考虑各种单药优化治疗方案(英文)

许多慢性抑郁症患者或反复发作的抑郁症患者对现有的各种抗抑郁药物治疗反应不理想。医生在治疗这些患者时,可能在原来抗抑郁药物的基础上增加其他药物,包括用第二种或第三种抗抑郁药物辅助治疗。虽然在高收入国家这是精神科医生和初级保健医生广泛使用的方法,但是证明这种抗抑郁药联合治疗方法有效的证据不多。只有当不同种类的抗抑郁药物的单药优化治疗方案无效后,才可谨慎使用联合治疗的方法。     

抗抑郁药联合使用治疗难治性抑郁症的临床研究进展

抑郁症是一常见的精神障碍,多呈慢性、复发性病程。目前,药物治疗仍然是最常用治疗方法。然而,有些患者对单一抗抑郁药物系统治疗反应不佳,即通常所称的难治性抑郁症(TRD)。针对TRD的治疗已有多种疗法,其中之一为抗抑郁药物的联合治疗,即同时用两种或以上的抗抑郁药物治疗,如米氮平联合SSRIs等。本文就目前抗抑郁药联合治疗TRD的研究进展进行综述。     

抗抑郁药疗效差异候选基因研究进展

抑郁症是临床常见的精神科疾病,但约有1/3的抑郁症患者对各类抗抑郁药物反应不佳。遗传因素可能影响抗抑郁药物的疗效,本文综述了抗抑郁药作用的遗传学机制研究进展。     

抗抑郁药疗效差异候选基因研究进展

抑郁症是临床常见的精神科疾病，但约有1／3的抑郁症患者对各类抗抑郁药物反应不佳。遗传因素可能影响抗抑郁药物的疗效，本文综述了抗抑郁药作用的遗传学机制研究进展。     

老年抑郁症药物治疗学研究进展（上）

老年抑郁症药物治疗学研究进展（上）刘贤臣王英杰抑郁症是老年人最常见的精神障碍，随着新型抗抑郁药物的出现，抗抑郁药物种类的增加，如何根据老年人的生理心理特点合理选择抗抑郁药物十分重要。Ｇｅｒｓｏｎ等综述了１９６４～１９８６年间以５５岁以上的老年抑郁症患...     

抗抑郁药物联合治疗抑郁症的时机(英文)

抑郁症是一种严重的精神障碍,单一抗抑郁药物系统治疗后往往只有部分患者改善,有些患者的症状可能毫无缓解。尽管针对这一"难治性"抑郁症患者亚群已经发展出多种不同的治疗方法,但许多患者仍然带着慢性抑郁症状生活,生活质量和整体功能受到严重影响。一种相对较新的难治性抑郁症治疗方法就是"抗抑郁药物联合治疗"——同时用两种或两种以上的抗抑郁药物治疗。正因为抑郁症不是单一病因学的疾病,该方法可以通过同时激活不同作用机制的多种神经通路来提高治疗结果。当然同时使用多种抗抑郁药物也可能会增加不良反应的发生率及其严重程度。进一步的研究工作将是评估该难治性抑郁症治疗方法的潜在益处和风险。     

抗抑郁药快速起效的重要性

抑郁症是一种常见的、慢性复发性疾病，它所导致的疾病负担和不良后果愈来愈得到重视。虽然在过去的40年抗抑郁药的研发和临床应用有了很大发展，但大多抗抑郁药的起效需2～4周，而抑郁症的临床处理往往又需要及时和迅速；因此，抗抑郁药能否快速起效的重要性日显突出。本文将就近年来国外对抗抑郁药物治疗快速起效的研究文献作一复习，希望引起重视。     

经颅磁刺激治疗抑郁症的临床研究

目的探讨经颅磁刺激治疗抑郁症患者的临床疗效。方法 80例抑郁症患者随机分为研究A组25例,研究B组25例,对照组30例,对照组予以抗抑郁药物+假刺激治疗,研究组予以抗抑郁药物联用经颅磁刺激治疗,A组予以高频磁刺激治疗,而B组予以低频磁刺激治疗,治疗4周,治疗前及治疗后4周末进行汉密尔顿抑郁量表(HAMD)评分,采用Asberg抗抑郁及副反应量表(SERS)评定不良反应。结果 A组与B组临床有效率、治疗前后HAMD对比无显著差异(P0.05),但皆明显优于对照组(P0.05);A组与B组不良反应发生率皆明显低于对照组(P0.05),同时B组不良反应发生率明显低于A组(P0.05)。结论低频与高频经颅磁刺激联合抗抑郁药物治疗抑郁症患者相较于单纯采取抗抑郁药物治疗可取得更好的临床效果,且HAMD评分改善相当,明显优于单纯用药,但低频治疗不良反应更少,值得推荐。     

Mood disorders in children and adolescents: psychopharmacological treatment.

Mood disorders are the leading causes of morbidity and mortality in children and adolescence. As a result, many adolescents are treated with psychopharmacologic agents such as antidepressants and mood stabilizers. To date, research into the safety and efficacy of these medications has lagged behind clinical practice. Several controlled trials of antidepressants in this population have recently been completed or are ongoing, yet few controlled trials of mood stabilizers have been conducted. Although acute efficacy of antidepressants is being addressed, many questions remain about pharmacological treatment of early-onset mood disorders. This article will focus on unmet research needs for the psychopharmacologic treatment of child and adolescent mood disorders.     

Is there a place for cellular therapy in depression?

Although efforts have been made to improve the pharmacological treatment of depression, approximately one-third of patients with depression do not respond to conventional therapy using antidepressants. Other potential non-pharmacological therapies have been studied in the last years, including the use of mesenchymal stem cell therapies to treat depression. These therapies are reviewed here since it is clinically relevant to develop innovative therapeutics to treat psychiatric patients. Experimental data corroborate that mesenchymal stem cell therapy could be considered a potential treatment for depression based on its anti-inflammatory and neurotrophic properties. However, some clinical trials involving treatment of depression with stem cells are in progress, but with no published results. These studies and other future clinical investigations will be crucial to define how much mesenchymal stem cells can effectively be used in psychiatric clinics as a strategy for supporting depression treatment.     

Major depressive disorder in adolescence: a brief review of the recent treatment literature.

OBJECTIVE: Treating adolescents with depression remains a major clinical and public health challenge. Because of the serious morbidity and mortality associated with adolescent major depressive disorder (MDD), there is a need to review the published literature on treatment efficacy to establish effective treatment choices for these adolescents. METHOD: We reviewed the recent literature on the treatment of MDD in adolescents using the Medline and PsycINFO computerized databases. RESULTS: Results of open studies of MDD treatment in adolescents suggested therapeutic efficacy; however, later, better-controlled studies are more difficult to interpret, owing to the high rate of improvement with placebo. Currently, there is limited evidence of robust, effective therapeutic interventions in children and in adolescent depressive disorders. CONCLUSIONS: Despite limitations, current findings from studies investigating selective serotonin reuptake inhibitors (SSRIs), cognitive-behavioural therapy, and interpersonal therapy generally support these treatments as safe and effective for adolescent MDD. Still, further investigations into these treatments for adolescent depression are warranted.     

Nontricyclic antidepressants: current trends in children and adolescents

OBJECTIVES: First, to review the extant data on the safety and efficacy of the use of nontricyclic antidepressants in children and adolescents; second, to identify the main limitations of our current knowledge in this area; and third, to point to future research directions. METHOD: A Medline search and a review of previous scientific meetings were conducted; all available reports on the efficacy and safety of nontricyclic antidepressants in children and adolescents were critically reviewed. RESULTS: As in adults, also in children nontricyclic antidepressants are potentially useful in treating a variety of psychiatric disorders. The data supporting their efficacy, however, are quite limited. Obsessive-compulsive disorder is the only psychiatric diagnosis for which pediatric use of selective serotonin reuptake inhibitors has been approved. One placebo-controlled study in children and adolescents with major depression supports the efficacy of fluoxetine. Other clinical trials of nontricyclic antidepressants in depressed adolescents are in progress. Available data indicate that the safety of these medications is good, at least in the short term. CONCLUSIONS: The potential usefulness of nontricyclic antidepressants for children and adolescents suffering from a range of disorders is considerable. While information from adults can suggest potential areas of possible efficacy in pediatric patients suffering from similar psychopathology, further research is essential to provide the necessary information on the efficacy, safety, and pharmacokinetics of these medications in children and adolescents.     

Developmentally informed pharmacotherapy for child and adolescent depressive disorders

This article reviews evidence-based pharmacotherapy for children and adolescents with depression. Several randomized controlled trials (RCTs) support the use of fluoxetine for the treatment of childhood and adolescent depression as well as escitalopram in the treatment of adolescent depression. To date, one RCT has demonstrated the effectiveness of sertraline or citalopram for the treatment of major depressive disorder in youth. Only a small number of RCTs for depression have included children, and none of these trials were adequately powered to detect differences in the efficacy of medication between children and adolescents.     

Pharmacological treatment of adolescent major depression

Antidepressant agents are widely prescribed for adolescents, although specific data regarding their efficacy in this age range are limited. The aims of the present article are to review research findings regarding the use of antidepressant drugs for adolescent depression and to discuss the main results in light of our clinical experience. Only 13 controlled trials on the use of antidepressant drugs for adolescent major depression are available in the literature. Six studies evaluated the efficacy of tricyclic antidepressants, yet they only included 196 adolescents altogether. Seven studies, including a total of 1,403 patients, evaluated the efficacy of three specific serotonin reuptake inhibitors: fluoxetine, paroxetine, and sertraline. Based on published data, serotonin reuptake inhibitors appear to be the first-line psychopharmacologic treatment for adolescent depression, as three compounds (fluoxetine, paroxetine, and sertraline) appeared to be effective in this indication. Conversely, all published studies failed to demonstrate that the tricyclic antidepressants were superior to placebo. Several questions remain open and are discussed: How should we use available scientific data in clinical practice? Are there nonspecific factors implicated in treatment response? Is there a serotonin hypothesis for juvenile depression? What are the priorities for future research?     

Refractory depression in children and adolescents

Refractory or treatments resistant depression in child and adolescent populations is a difficult construct to operationalize currently. To date, only one of the small number of completed double-blind placebo-controlled treatment investigations have not demonstrated a significant effect of antidepressants in comparison to placebo. However, it has been established that child and adolescent MDD is a serious disorder that appears to have clinical continuity with adult affective disorders and is generally of long duration with high rates of recurrence and eventual progression to mania, substance abuse, or other serious psychopathology. In addition, families of children with affective disorders evidence substantial genetic loading with high rates of affective disorders contributing both genetic vulnerability and potential environmental risk as well. There have been no empirically identified treatments that alter the long-term course of the illness. Thus treatment resistance is a significant issue for this population. This review will focus on controlled treatment trials and will examine the potential relevance of psychosocial impairment, genetic-familial risk, and neuromorphometric brain differences to treatment resistance in children and adolescents with major depression. Depression and Anxiety 5:212–223, 1997. © 1997 Wiley-Liss, Inc.     

Depressive disorders in children and adolescents

Depressive disorders in children and adolescents are valid clinical entities which can be identified using adult diagnostic criteria. Recent research has resulted in significant progress in the areas of diagnosis, epidemiology, family pathology, pharmacokinetics and psychopharmacology. Many rating instruments have been developed to screen, diagnose and measure changes of depression in children and adolescents. The prevalence of depressive disorders in prepubertal children is about 2% and in adolescents about 5%. Depressive episodes are usually of long duration, with high rates of relapse. These relapses are usually associated with school, family and social failure. Follow-up studies of depressed adolescents indicated that about half of the patients continue to suffer from mood disturbances and psycho-social adaptational problems. In North America suicidal behaviour in adolescents has increased 300% in the past 30 years. However, its relationship to depression is more complex than in adults. There is a significant excess of affective illness and alcoholism in the families of depressed adolescents. Similarly, there is a high rate of impairment among children of parents with affective disorders. During depressive episodes, prepubertal children show abnormalities of growth hormone and cortisol secretion. However, DST findings are contradictory. Polysomnographic findings in childhood depression appear unremarkable. In adolescent depression these findings are similar to those in depressed adults. Biological manifestations of depressive disorders may be significantly affected by developmental and hormonal changes. Antidepressants have been effective in the therapy of several disorders in childhood. These include enuresis, school phobias, attention deficit, conduct disorders and obsessive-compulsive disorders. Open drug studies suggest that antidepressants are useful in depressed children.(ABSTRACT TRUNCATED AT 250 WORDS)     

A review of pharmacotherapy of major depression in children and adolescents

OBJECTIVE: The review examined the historical progression and current status of pharmacotherapy of child and adolescent major affective disorder. METHODS: A MEDLINE search was used to identify double-blind, placebo-controlled studies of child and adolescent major depression. Only studies that used reliable diagnostic and recovery parameters were included. RESULTS: Few well-designed studies have compared placebo and tricyclic antidepressants in the treatment of major depressive disorder in children and adolescents. However, results consistently suggest that tricyclic antidepressants are not efficacious. Early results of double-blind placebo-controlled trials with fluoxetine and paroxetine have shown a significant drug effect. However, the results are inconsistent, which could reflect the ways that response to medication is defined, the ways that rating scales measure recovery, and uncertainties of dosing strategies with second-generation antidepressants. Hypothesized reasons for the unique response pattern in youths include the changing hormonal status of children, the differential maturation of the noradrenergic versus serotonergic neurotransmitter systems, and the possibility that a large proportion of depressed youths are in the early stages of bipolar disorder, which is not effectively treated by these medications. CONCLUSIONS: Tricyclic antidepressants are not superior to placebo for the treatment of child and adolescent major depressive disorder. Although two of three trials of second-generation antidepressants in this age group have had negative results, data suggest that these drugs may be more promising. It is too early in our investigation to know whether these agents will be effective in treating major depressive disorder in children and adolescents.     

Clinical guidelines for depressive disorders in childhood and adolescence

 Major depressive and dysthymic disorders are recurrent and sometimes persistent unipolar mood disorders, which often present in childhood and adolescence. Depressive episodes may increase in severity and duration with recurrence and are associated with substantial morbidity and risk of suicide. The role of child and adolescent mental health services in early intervention and management is thus of major importance. This paper draws together current research evidence and common clinical practice, in guidelines for the specialist management of depressive disorders in childhood and adolescence. Both psychotherapy and pharmacotherapy have been found to be beneficial for the acute treatment of children and adolescents with depressive disorders. Based on current evidence, psychotherapy may be the first treatment for most depressed youngsters, but antidepressants should be considered for those with severe depression. All patients need continuation therapy, and some will need maintenance treatment. Evidence supporting the efficacy of psychological and psychopharmacological treatments are reviewed. An integration of approaches is suggested as a guideline for treatment planning. Accepted: 15 February 2000