课件：抑郁症的治疗.pptVIP

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 * Patients often do not recognize the symptoms of depression, but rather focus on various somatic concerns such as headaches or fatigue. They also underestimate the severity of their depression and do not pursue treatment. Lack of education and training for physicians and time constraints also contribute to the clinical underrecognition and undertreatment of depression. Physicians should take care to recognize and diagnose depression among patients in their practice, even among those not complaining specifically of symptoms of depression Research has shown that many patients treated with antidepressant medications are not given adequate doses for a long enough period of time. Physicians should ensure that adequate doses of medication are instituted and that patients are treated for an adequate duration Response to antidepressant medications varies among patients. An individual may respond better to one antidepressant than another. A series of trials of several different agents may be required to identify the optimal treatment for a particular patient (ie, the one that is most effective and best tolerated on a long-term basis). The use of combination therapy and/or augmentation strategies should be considered for appropriate patients Poor patient adherence is a common problem contributing to nonresponse, partial response, and relapse. Education and information should be provided to the patient and family to combat this problem. A collaborative approach between the clinician and patient should be used. Obstacles to adherence should be prospectively identified and eliminated to the extent possible Finally, patients should be educated that remission, and not just an improvement in symptoms, is the goal of treatment