临床治愈抑郁症治疗的演示文稿.pptVIP

* The nigrostriatal dopaminergic system originates in the substantia nigra and terminates in the main dorsal part of the striatum. Dopamine neurons in the posterior hypothalamus project to the spinal cord. The tuberoinfundibular dopaminergic neurons exert inhibitory control over the release of prolactin. Hyperprolactinemia has been linked to psychological symptoms, especially anxiety and depression. The ventral tegmental area (VTA) is the origination zone for dopaminergic neurons involved in reward-seeking behavior, which has been linked to addiction and substance abuse. The VTA releases galanin in response to increased activity of the locus ceruleus neurons. Galanin may inhibit the activity of dopaminergic cell bodies in this region, whose axons project to the forebrain, thus leading to 2 of the principal symptoms seen in depression: decreased motor activation and decreased appreciation of pleasurable stimuli (anhedonia). Dopamine modulates various brain functions, including mood, cognition, motor function, motivation, drive, aggression, and pleasure. Kaplan HI, Sadock BJ. Synopsis of Psychiatry: Behavioral Sciences, Clinical Psychiatry. 8th ed. 1998: chap 3. Hardman JG, et al. Goodman Gilman’s The Pharmacological Basis of Therapeutics. 9th ed. 1996. * * Key Point The goal of depression treatment is remission, defined as minimal or no symptoms and a return to normal functioning in all life domains Background Numerous clinical guidelines, including those from the American Psychiatric Association, the Agency for Healthcare Policy and Research, and the British Association for Psychopharmacology, have advocated that the goal for the treatment of MDD be complete remission The DSM-IV defines full remission as no signs or symptoms of the disturbance for the previous two months The American Society of Clinical Psychopharmacology notes that remission involves relief of virtually all signs and symptoms of the depressive disorder, with a return to premorbid levels of func