老年抑郁症诊治的研究进展
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摘要
在我国大概有22.6%的老年人患有不同程度的抑郁症状,严重影响患者的情绪、社会功能以及生命质量,而且是老年痴呆的风险因子。另外,目前对于老年抑郁症患者的用药参考的往往是针对年轻抑郁症患者的方案,这样的做法可能会增加老年患者的用药风险,因此本文通过文献搜索,对老年抑郁症最新的诊疗进展进行综述,为更好地治疗这个疾病提供一些最新的临床依据。
In China,about 22.6% of the old people have different kinds of depression symptoms,which affects the emotions,social functions and quality of life of them.Depression is also an independent indicator for dementia in the elderly.In recent years,the treatment protocol for elderly was usually based the guideline designed for younger patients,which will increase the medicine risk among the old people.Thus,this study is designed to report updated evaluation and treatments of depression in the elderly providing the physicians clinical evidence for this disease.
In China,about 22.6% of the old people have different kinds of depression symptoms,which affects the emotions,social functions and quality of life of them.Depression is also an independent indicator for dementia in the elderly.In recent years,the treatment protocol for elderly was usually based the guideline designed for younger patients,which will increase the medicine risk among the old people.Thus,this study is designed to report updated evaluation and treatments of depression in the elderly providing the physicians clinical evidence for this disease.
引文
[1]BLAZER D G.Depression in late life:review and commentary[J].J Gerontol A Biol Sci Med Sci,2003,58(3):249-265.
[2]张玲,徐勇,聂宏伟.2000~2010年中国老年人抑郁患病率的meta分析[J].中国老年学杂志,2011,31(17):3349-3352.
[3]JACKSON J C,PANDHARIPANDE P P,GIRARD T D,et al.Depression,post-traumatic stress disorder,and functional disability in survivors of critical illness in the BRAIN-ICU study:a longitudinal cohort study[J].Lancet Respir Med,2014,2(5):369-379.
[4]TAYLOR W D,AIZENSTEIN H J,ALEXOPOULOS G S.The vascular depression hypothesis:mechanisms linking vascular disease with depression[J].Mol Psychiatry,2013,18(9):963-974.
[5]AMERICAN PSYCHIATRIC ASSOCIATION.Diagnostic and statistical manual of mental disorders[M].5th ed.Arlington,VA:American Psychiatric Publishing,2013:155-188.
[6]MOJTABAI R.Diagnosing depression in older adults in primary care[J].N Engl J Med,2014,370(13):1180-1182.
[7]CONWELL Y,THOMPSON C.Suicidal behavior in elders[J].Psychiatr Clin North Am,2008,31(2):333-356.
[8]SACZYNSKI J S,BEISER A,SESHADRI S,et al.Depressive symptoms and risk of dementia:the Framingham Heart Study[J].Neurology,2010,75(1):35-41.
[9]JIANG W,ALEXANDER J,CHRISTOPHER E,et al.Relationship of depression to increased risk of mortality and rehospitalization in patients with congestive heart failure[J].Arch Intern Med,2001,161(15):1849-1856.
[10]BRIDLE C,SPANJERS K,PATEL S,et al.Effect of exercise on depression severity in older people:systematic review and meta-analysis of randomised controlled trials[J].Br J Psychiatry,2012,201(3):180-185.
[11]SCHNEIDER L S,NELSON J C,CLARY C M,et al.An 8-week multicenter,parallel-group,double-blind,placebo-controlled study of sertraline in elderly outpatients with major depression[J].Am J Psychiatry,2003,160(7):1277-1285.
[12]SHEIKH J I,CASSIDY E L,DORAISWAMY P M,et al.Efficacy,safety,and tolerability of sertraline in patients with late-life depression and comorbid medical illness[J].J Am Geriatr Soc,2004,52(1):86-92.
[13]TOLLEFSON G D,BOSOMWORTH J C,HEILIGENSTEIN J H,et al.A double-blind,placebo-controlled clinical trial of fluoxetine in geriatric patients with major depression[J].Int Psychogeriatr,1995,7(1):89-104.
[14]RAPAPORT M H,SCHNEIDER L S,DUNNER D L,et al.Efficacy of controlled-release paroxetine in the treatment of late-life depression[J].J Clin Psychiatry,2003,64(9):1065-1074.
[15]BOSE A,LI D,GANDHI C.Escitalopram in the acute treatment of depressed patients aged 60years or older[J].Am J Geriatr Psychiatry,2008,16(1):14-20.
[16]KASPER S,DE SWART H,FRIIS A H.Escitalopram in the treatment of depressed elderly patients[J].Am J Geriatr Psychiatry,2005,13(10):884-891.
[17]ROOSE S P,SACKEIM H A,KRISHNAN K R,et al.Antidepressant pharmacotherapy in the treatment of depression in the very old:a randomized,placebo-controlled trial[J].Am J Psychiatry,2004,161(11):2050-2059.
[18]SMOLLER J W,ALLISON M,COCHRANE B B,et al.Antidepressant use and risk of incident cardiovascular morbidity and mortality among postmenopausal women in the Women's Health Initiative study[J].Arch Intern Med,2009,169(22):2128-2139.
[19]RASKIN J,WILTSE C G,SIEGAL A,et al.Efficacy of duloxetine on cognition,depression,and pain in elderly patients with major depressive disorder:an 8-week,double-blind,placebo-controlled trial[J].Am J Psychiatry,2007,164(6):900-909.
[20]SCHATZBERG A,ROOSE S.A double-blind,placebo-controlled study of venlafaxine and fluoxetine in geriatric outpatients with major depression[J].Am J Geriatr Psychiatry,2006,14(4):361-370.
[21]AMERICAN GERIATRICS SOCIETY 2012 BEERS CRITERIA UPDATE EXPERT PANEL.American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults[J].J Am Geriatr Soc,2012,60(4):616-631.
[22]WEIHS K L,SETTLE E C JR,BATEY S R,et al.Bupropion sustained release versus paroxetine for the treatment of depression in the elderly[J].J Clin Psychiatry,2000,61(3):196-202.
[23]GERHARD T,AKINCIGIL A,CORRELL C U,et al.National trends in second-generation antipsychotic augmentation for nonpsychotic depression[J].J Clin Psychiatry,2014,75(5):490-497.
[24]SHEFFRIN M,DRISCOLL H C,LENZE E J,et al.Pilot study of augmentation with aripiprazole for incomplete response in latelife depression:getting to remission[J].J Clin Psychiatry,2009,70(2):208-213.
[25]STEFFENS D C,NELSON J C,EUDICONE J M,et al.Efficacy and safety of adjunctive aripiprazole in major depressive disorder in older patients:apooled subpopulation analysis[J].Int J Geriatr Psychiatry,2011,26(6):564-572.
[26]KIOSSES D N,LEON A C,AREN P A.Psychosocial interventions for late-life major depression:evidence-based treatments,predictors of treatment outcomes,and moderators of treatment effects[J].Psychiatr Clin North Am,2011,34(2):377-401.
[27]GOULD R L,COULSON M C,HOWARD R J.Cognitive behavioral therapy for depression in older people:a meta-analysis and metaregression of randomized controlled trials[J].J Am Geriatr Soc,2012,60(10):1817-1830.
[28]PINQUART M,DUBERSTEIN P R,LYNESS J M.Effects of psychotherapy and other behavioral interventions on clinically depressed older adults:a meta-analysis[J].Aging Ment Health,2007,11(6):645-657.
[29]AREN P A,RAUE P,MACKIN R S,et al.Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction[J].Am J Psychiatry,2010,167(11):1391-1398.
[30]REYNOLDS C FⅢ,DEW M A,POLLOCK B G,et al.Maintenance treatment of major depression in old age[J].N Engl J Med,2006,354(11):1130-1138.
[31]PRUDIC J,OLFSON M,MARCUS S C,et al.Effectiveness of electro-convulsive therapy in community settings[J].Biol Psychiatry,2004,55(3):301-312.
[32]PRUDIC J,HASKETT R F,MCCALL W V,et al.Pharmacological strategies in the prevention of relapse after electroconvulsive therapy[J].J ECT,2013,29(1):3-12.
[33]GEORGE M S,LISANBY S H,AVERY D,et al.Daily left prefrontal transcranial magnetic stimulation therapy for major depressive disorder:a sham-controlled randomized trial[J].Arch Gen Psychiatry,2010,67(5):507-516.
[34]SLOTEMA C W,BLOM J D,HOEK H W,et al.Should we expand the toolbox of psychiatric treatment methods to include repetitive transcranial magnetic stimulation(rTMS)?A meta-analysis of the efficacy of rTMS in psychiatric disorders[J].J Clin Psychiatry,2010,71(7):873-884.
[35]PALLANTI S,CANTISANI A,GRASSI G,et al.rTMS age-dependent response in treatment-resistant depressed subjects:a mini review[J].CNS Spectr,2012,17(1):24-30.
[36]REYNOLDS C FⅢ,FRANK E,PEREL J M,et al.Nortriptyline and interpersonal psychotherapy as maintenance therapies for recurrent major depression:a randomized controlled trial in patients older than 59years[J].JAMA,1999,281(1):39-45.
[37]REYNOLDS C FⅢ,BUTTERS M A,LOPEZ O,et al.Maintenance treatment of depression in old age:a randomized,doubleblind,placebo-controlled evaluation of the efficacy and safety of donepezil combined with antidepressant pharmacotherapy[J].Arch Gen Psychiatry,2011,68(1):51-60.
[2]张玲,徐勇,聂宏伟.2000~2010年中国老年人抑郁患病率的meta分析[J].中国老年学杂志,2011,31(17):3349-3352.
[3]JACKSON J C,PANDHARIPANDE P P,GIRARD T D,et al.Depression,post-traumatic stress disorder,and functional disability in survivors of critical illness in the BRAIN-ICU study:a longitudinal cohort study[J].Lancet Respir Med,2014,2(5):369-379.
[4]TAYLOR W D,AIZENSTEIN H J,ALEXOPOULOS G S.The vascular depression hypothesis:mechanisms linking vascular disease with depression[J].Mol Psychiatry,2013,18(9):963-974.
[5]AMERICAN PSYCHIATRIC ASSOCIATION.Diagnostic and statistical manual of mental disorders[M].5th ed.Arlington,VA:American Psychiatric Publishing,2013:155-188.
[6]MOJTABAI R.Diagnosing depression in older adults in primary care[J].N Engl J Med,2014,370(13):1180-1182.
[7]CONWELL Y,THOMPSON C.Suicidal behavior in elders[J].Psychiatr Clin North Am,2008,31(2):333-356.
[8]SACZYNSKI J S,BEISER A,SESHADRI S,et al.Depressive symptoms and risk of dementia:the Framingham Heart Study[J].Neurology,2010,75(1):35-41.
[9]JIANG W,ALEXANDER J,CHRISTOPHER E,et al.Relationship of depression to increased risk of mortality and rehospitalization in patients with congestive heart failure[J].Arch Intern Med,2001,161(15):1849-1856.
[10]BRIDLE C,SPANJERS K,PATEL S,et al.Effect of exercise on depression severity in older people:systematic review and meta-analysis of randomised controlled trials[J].Br J Psychiatry,2012,201(3):180-185.
[11]SCHNEIDER L S,NELSON J C,CLARY C M,et al.An 8-week multicenter,parallel-group,double-blind,placebo-controlled study of sertraline in elderly outpatients with major depression[J].Am J Psychiatry,2003,160(7):1277-1285.
[12]SHEIKH J I,CASSIDY E L,DORAISWAMY P M,et al.Efficacy,safety,and tolerability of sertraline in patients with late-life depression and comorbid medical illness[J].J Am Geriatr Soc,2004,52(1):86-92.
[13]TOLLEFSON G D,BOSOMWORTH J C,HEILIGENSTEIN J H,et al.A double-blind,placebo-controlled clinical trial of fluoxetine in geriatric patients with major depression[J].Int Psychogeriatr,1995,7(1):89-104.
[14]RAPAPORT M H,SCHNEIDER L S,DUNNER D L,et al.Efficacy of controlled-release paroxetine in the treatment of late-life depression[J].J Clin Psychiatry,2003,64(9):1065-1074.
[15]BOSE A,LI D,GANDHI C.Escitalopram in the acute treatment of depressed patients aged 60years or older[J].Am J Geriatr Psychiatry,2008,16(1):14-20.
[16]KASPER S,DE SWART H,FRIIS A H.Escitalopram in the treatment of depressed elderly patients[J].Am J Geriatr Psychiatry,2005,13(10):884-891.
[17]ROOSE S P,SACKEIM H A,KRISHNAN K R,et al.Antidepressant pharmacotherapy in the treatment of depression in the very old:a randomized,placebo-controlled trial[J].Am J Psychiatry,2004,161(11):2050-2059.
[18]SMOLLER J W,ALLISON M,COCHRANE B B,et al.Antidepressant use and risk of incident cardiovascular morbidity and mortality among postmenopausal women in the Women's Health Initiative study[J].Arch Intern Med,2009,169(22):2128-2139.
[19]RASKIN J,WILTSE C G,SIEGAL A,et al.Efficacy of duloxetine on cognition,depression,and pain in elderly patients with major depressive disorder:an 8-week,double-blind,placebo-controlled trial[J].Am J Psychiatry,2007,164(6):900-909.
[20]SCHATZBERG A,ROOSE S.A double-blind,placebo-controlled study of venlafaxine and fluoxetine in geriatric outpatients with major depression[J].Am J Geriatr Psychiatry,2006,14(4):361-370.
[21]AMERICAN GERIATRICS SOCIETY 2012 BEERS CRITERIA UPDATE EXPERT PANEL.American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults[J].J Am Geriatr Soc,2012,60(4):616-631.
[22]WEIHS K L,SETTLE E C JR,BATEY S R,et al.Bupropion sustained release versus paroxetine for the treatment of depression in the elderly[J].J Clin Psychiatry,2000,61(3):196-202.
[23]GERHARD T,AKINCIGIL A,CORRELL C U,et al.National trends in second-generation antipsychotic augmentation for nonpsychotic depression[J].J Clin Psychiatry,2014,75(5):490-497.
[24]SHEFFRIN M,DRISCOLL H C,LENZE E J,et al.Pilot study of augmentation with aripiprazole for incomplete response in latelife depression:getting to remission[J].J Clin Psychiatry,2009,70(2):208-213.
[25]STEFFENS D C,NELSON J C,EUDICONE J M,et al.Efficacy and safety of adjunctive aripiprazole in major depressive disorder in older patients:apooled subpopulation analysis[J].Int J Geriatr Psychiatry,2011,26(6):564-572.
[26]KIOSSES D N,LEON A C,AREN P A.Psychosocial interventions for late-life major depression:evidence-based treatments,predictors of treatment outcomes,and moderators of treatment effects[J].Psychiatr Clin North Am,2011,34(2):377-401.
[27]GOULD R L,COULSON M C,HOWARD R J.Cognitive behavioral therapy for depression in older people:a meta-analysis and metaregression of randomized controlled trials[J].J Am Geriatr Soc,2012,60(10):1817-1830.
[28]PINQUART M,DUBERSTEIN P R,LYNESS J M.Effects of psychotherapy and other behavioral interventions on clinically depressed older adults:a meta-analysis[J].Aging Ment Health,2007,11(6):645-657.
[29]AREN P A,RAUE P,MACKIN R S,et al.Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction[J].Am J Psychiatry,2010,167(11):1391-1398.
[30]REYNOLDS C FⅢ,DEW M A,POLLOCK B G,et al.Maintenance treatment of major depression in old age[J].N Engl J Med,2006,354(11):1130-1138.
[31]PRUDIC J,OLFSON M,MARCUS S C,et al.Effectiveness of electro-convulsive therapy in community settings[J].Biol Psychiatry,2004,55(3):301-312.
[32]PRUDIC J,HASKETT R F,MCCALL W V,et al.Pharmacological strategies in the prevention of relapse after electroconvulsive therapy[J].J ECT,2013,29(1):3-12.
[33]GEORGE M S,LISANBY S H,AVERY D,et al.Daily left prefrontal transcranial magnetic stimulation therapy for major depressive disorder:a sham-controlled randomized trial[J].Arch Gen Psychiatry,2010,67(5):507-516.
[34]SLOTEMA C W,BLOM J D,HOEK H W,et al.Should we expand the toolbox of psychiatric treatment methods to include repetitive transcranial magnetic stimulation(rTMS)?A meta-analysis of the efficacy of rTMS in psychiatric disorders[J].J Clin Psychiatry,2010,71(7):873-884.
[35]PALLANTI S,CANTISANI A,GRASSI G,et al.rTMS age-dependent response in treatment-resistant depressed subjects:a mini review[J].CNS Spectr,2012,17(1):24-30.
[36]REYNOLDS C FⅢ,FRANK E,PEREL J M,et al.Nortriptyline and interpersonal psychotherapy as maintenance therapies for recurrent major depression:a randomized controlled trial in patients older than 59years[J].JAMA,1999,281(1):39-45.
[37]REYNOLDS C FⅢ,BUTTERS M A,LOPEZ O,et al.Maintenance treatment of depression in old age:a randomized,doubleblind,placebo-controlled evaluation of the efficacy and safety of donepezil combined with antidepressant pharmacotherapy[J].Arch Gen Psychiatry,2011,68(1):51-60.