期刊
JOURNAL OF PSYCHIATRIC RESEARCH
卷 41, 期 3-4, 页码 189-206出版社
PERGAMON-ELSEVIER SCIENCE LTD
DOI: 10.1016/j.jpsychires.2006.05.008
关键词
tricyclic antidepressant; selective serotonin reuptake inhibitor; serotonin norepinephrine reuptake inhibitor; electroconvulsive therapy; vagus nerve stimulation; transcranial magnctic stimulation; severe depression
类别
资金
- NATIONAL INSTITUTE OF MENTAL HEALTH [R01MH042088, U19MH069056] Funding Source: NIH RePORTER
- NIMH NIH HHS [MH 52899, MH-69056, MH-42088] Funding Source: Medline
Among the factors making recognition of severe depression problematic for clinicians are the heterogeneous nature of the condition, lack of standardized definitions, and concomitant comorbidities that confound differential diagnosis of symptoms. The spectrum of severity in depressive disorders is extraordinarily broad, and severity assessment is comprised of several metrics including symptom intensity, diagnostic subtypes, suicidatity risk, and hospitalization status. The overall diagnosis is achieved through consideration of symptom types and severities together with the degree of functional impairment as assessed by the psychiatric interview. It is likely that no single fundamental neurobiological defect underlies severe depression. The chronicity and heterogeneity of this disorder lead to frequent clinic visits and a longer course of treatment; therefore, successful approaches may require an arsenal of treatments with numerous mechanisms of action. The categories of drugs used to treat severe depression are detailed herein, as are several non-pharmacologic options including a number of experimental treatments. Pharmacotherapies include tricyclic antidepressants, selective serotonin reuptake inhibitors, atypical antidepressants such as serotonin-norepinephrine reuptake inhibitors and monoamine oxidase inhibitors, and combination and augmentation therapies. Drugs within each class are not equivalent, and efficacy may vary with symptom severity. Patient adherence makes tolerability another critical consideration in antidepressant choice. The role of non-pharmacological treatments such as electroconvulsive therapy, vagus nerve stimulation, transcranial magnetic stimulation, and deep brain stimulation remain active avenues of investigation. Improved knowledge and treatment approaches for severe depression are necessary to facilitate remission, the ideal treatment goal. (c) 2006 Elsevier Ltd. All rights reserved.
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