难治性心境障碍治疗原则及范例课件.pptVIP

治疗原则—合并用药 （3） 2种不同类型或不同药理机制的抗抑郁药联用 SSRIs + SARI SSRIs + SNRI/ NaSSA SNRIs + NaSSA 治疗原则—合并用药（4） 抗抑郁药物合并生物心理社会综合干预措施 抗抑郁药合并电抽搐治疗 联合用药 一般不推荐2种以上抗抑郁药联用 对难治性病例在足量、足疗程、同类型和不同类型抗抑郁药无效或部分有效时才考虑联合用药，以增强疗效，弥补单药治疗的不足和减少不良反应 对绝经期前后的妇女所伴发的抑郁障碍不主张抗抑郁药联用雌激素治疗 抑郁症药物治疗流程 抑郁症（CCMD-3） 组内换药 组间换药 增效剂（Li, T3） 二线用药 联合用药 ECT 继续治疗 组内或组间换药 继续治疗 加量 继续治疗4-6个月 维持治疗时间不定 单一药物治疗（一线药）TCA，SSRI或SNRI 减量或换药 严重或自杀强烈者可首选 完全缓解 有维持治疗特征 有效 有效 有效 有效 有效 有效 无效 无效 无效 无效 无效 无效 重新审查诊断，躯体病，物质依赖心理应激和服药依从性 TCA：约 20-30%有效SSRI：约 30-50%有效 无或部分反应 不良反应 * * Key Points: In this study, both duloxetine and escitalopram showed significant improvement compared with placebo in treating symptoms of MDD. Duloxetine was non-inferior to escitalopram in onset of antidepressant action. Probabilities of meeting onset criteria for duloxetine- and escitalopram-treated patients were 42.6% vs. 35.2%, respectively (treatment difference = 7.4%; 95% confidence interval, -1.3% to 16.2%; p=.097). At endpoint, the only significant difference for duloxetine vs. escitalopram was on HAMA tiem-5 (cognitive). Duloxetine and escitalopram were both significantly superior to placebo on mean change in HAMD-17 Maier subscale at the study endpoint (p.001 and p=.021, respectively), while only duloxetine was superior to placebo on mean change in HAMD-17 total score (p=.021). Both duloxetine and escitalopram were significantly superior to placebo on CGI-S, PGI-I, and HADS total score at study endpoint, but no advantage over placebo was observed for either active drug on HAMA total score. Background: This was an 8-week, randomized, double-blind, fixed-dose, active comparator and placebo-contolled study used to assess the onset of antidepressant action of duloxetine vs. escitalopram and placebo in patients with major depressive disorder (MDD). Patients were randomized 2:2:1 for duloxetine, escitalopram, and placebo respectively. This study incorporated a double-blind, variable-length, placebo lead-in period. Investigators and patients were blinded to t