抑郁症患者伴焦虑失眠的处理.ppt

联合用药的方案美抒玉推荐剂量：50-100mg/天起始可25mg，3-4天后增量第63页,共66页，2024年2月25日，星期天用药建议起始剂量50mg未使用过中枢药物治疗者，起始剂量25mg每3~4天增加50mg睡前1~2小时服用150mg/日以上者分次服用，大部分剂量在睡前服用第64页,共66页，2024年2月25日，星期天小结抑郁症患者常伴有焦虑失眠等症状抑郁症伴焦虑失眠的危害严重高于单一的抑郁症患者SSRI/SNRI治疗初始阶段可出现或加重患者的焦虑、失眠症状，及出现性功能障碍SSRI/SNRI联合SARI类的美抒玉可增加抗抑郁焦虑的疗效，同时有效治疗失眠及性功能障碍。第65页,共66页，2024年2月25日，星期天感谢大家观看第66页,共66页，2024年2月25日，星期天**KeyPoint Inrecentyears,depressionhasbeenincreasinglyrecognizedasasystemicillness,withawidevarietyofemotionalandphysicalsignsandsymptomsBackgroundInadditiontodepressedmoodandanhedonia,emotionalsymptomsassociatedwithMDDincludefeelingsofhopelessness,lowself-esteem,impairedmemory,difficultyconcentrating,andanxietyPatientswithMDDalsofrequentlypresentwithawidevarietyofphysicalcomplaints,includingheadache,sleepdisturbances,painsymptoms,etcAsthesesymptomsaregeneralinnature,itisimportanttoobtainacomplete

medicalhistoryandtoruleoutotherphysicalillnessestoensureanaccuratediagnosis

ofdepressionReferencesDSM-IV-TR?.Washington,DC:AmericanPsychiatricAssociation;2000.KroenkeK,etal.ArchFamMed.1994;3:774-779.***Gas大体评定量表***TheHamiltonRatingScaleforDepression(HRSD),alsoknownastheHamiltonDepressionRatingScale(HDRS)orHAM-D,isa21-questionmultiplechoicequestionnairethatcliniciansmayusetoratetheseverityofapatientsmajordepression.[1]****Recoveringsleeparchitecturetoanormalsituationmightavoidthepersistenceofinsomniaafterclinicalremissionorbethetriggertoanewdepressiveepisode.*Antidepressantscanhaveaneffectonmanypharmacologicalreceptorsandreuptaketransporters.Theirinteractionwiththesereceptorsand/orreuptaketransportersdeterminetheirefficacyandside-effectprofile.RichelsonE.Reviewofantidepressantsinthetreatmentofmooddisorders.In:CurrentPsychiatricTherapy2nded.DLDunner(ed).WBSaundersCompany199