Depression is a common mood disorder, with a high incidence and prevalence, while the overall diagnosis and treatment rate are low.Even if patients attained the initial clinical cure, there is still a high risk of depression recurrence, of which a great part may turn into self-mutilation or even suicide.Taking antidepressants as the most preferred treatment of moderate and major depression is recommended by almost all clinical treatment guidelines at home and abroad currently.At the same time, the concept of depression treatment is changing gradually from the initial single-mode drug therapy for symptom control to a comprehensive, individualized, quantitative treatment model.Promising psychological treatment, physical therapy and other alternative and complementary treatments are developing quickly.
Patients with chronic depression (CD) by definition respond less well to standard forms of psychotherapy, so they are more likely to be high utilizers of psychiatric resources. Therefore, the aim of this guidance paper is to provide a comprehensive overview of current psychotherapy for CD. The evidence of efficacy is critically reviewed and recommendations for clinical applications and research are given. We performed a systematic literature search to identify studies on psychotherapy in CD, evaluated the retrieved documents and developed evidence tables and recommendations through a consensus process among experts and stakeholders. We developed 5 recommendations which may help providers to select psychotherapeutic treatment options for this patient group. The EPA considers both psychotherapy and pharmacotherapy to be effective in CD and recommends both approaches. The best effect is achieved by combined treatment with psychotherapy and pharmacotherapy, which should therefore be the treatment of choice. The EPA recommends psychotherapy with an interpersonal focus (e.g. the Cognitive Behavioural Analysis System of Psychotherapy [CBASP]) for the treatment of CD and a personalized approach based on the patient's preferences. The DSM-5 nomenclature of persistent depressive disorder (PDD), which includes CD subtypes, has been an important step towards a more differentiated treatment and understanding of these complex affective disorders. Apart from dysthymia, ICD-10 still does not provide a separate entity for a chronic course of depression. The differences between patients with acute episodic depression and those with CD need to be considered in the planning of treatment. Specific psychotherapeutic treatment options are recommended for patients with CD. Patients with chronic forms of depression should be offered tailored psychotherapeutic treatments that address their specific needs and deficits. Combination treatment with psychotherapy and pharmacotherapy is the first-line treatment recommended for CD. More research is needed to develop more effective treatments for CD, especially in the longer term, and to identify which patients benefit from which treatment algorithm.
抗抑郁药物在治疗患有重度抑郁症或者更严重的成人中有很明显的效果(药物反应率为48%-50%,比安慰剂30-32%高出接近20个百分点)。另外也有部分研究发现结合多种抗抑郁药物,或者在早期增大SSRIs用量的话,疗效可能更好。而对于年龄65岁或者更老的患者,药物疗效的反应率与安慰剂的对比差异就没有那么大了。对于年龄小于13岁的小孩,药物和安慰剂的差异很小,并不显著。抑郁症同样对那些患有生理疾病的抑郁患者有效,但是在患有内科疾病(比如高血压,关节炎,肝炎)的患者中疗效较差。对于安慰剂效应,病情越重的抑郁症和忧郁症中安慰剂效应较小,反之,程度较轻,时间较短并且由之前的生活事件所引发的话抑郁症则安慰剂效应较大。当然,有很多研究争论说药物只在病症严重的患者中才有效果,其实并不是这样,虽然药物在程度严重的患者中效果更好,但是在程度较轻的患者中仍然有明显的医疗效果,而且值得注意的是即使不是精神类药物而是我们日常用的药物,它们的安慰剂与药效的对比其实也是相似的数据,只是我们大众和媒体平时过于关注精神类药物才导致我们觉得精神类药物效果差副作用大(这方面我之前的回答链接里有提到)。
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