抑郁症的研究进展

:266034山东省青岛市精神卫生中心[]张少丽(1976-),女,山东烟台人,主治医师,主要从事精神科临床张少丽石少波抑郁症是目前精神科的一种常见病和多发病,正确治疗对节约政府开支减轻经济负担极其重要本文对抑郁症的药物治疗社会心理治疗联合疗法物理疗法方面的研究进展作一综述抑郁症治疗R749.4A10097201(2008)02015605,,4.2%,6.9%,113%;(GBD),(DALY),/,[1],,,11.1;5HT,:(),(),()1.2(MAO)MAOAMAO,,MAOMAO,MAO,,MAOA,1.35(5HT)(SSRI)5HTSSRI,,,SSRI,;,,,;SSRI,5HTSSRI1.45HT25HT,5HT(NE),NE5HT,NE,5HTNE5HT,,,1.5[2],(),,1.6,,,,,1562008212JournalofPsychiatry,2008,Vol21,No.21.7(NOS)[3~6],(NO)NOSNOS[7,8],NONOS1.8,5HT,(PMS),[9]1.9NemeroffCB[10],0.8mmol/L,;0.8mmol/L,,[11]6~8,,(),[12],,1.10[13],,,,1.11,,,,30%,,1/3,35%40%[14]1.12,,Post,,,(TCA)(MAOI),TCAPeet,SSRI3.7%TCA11.2%1/3,4.2%,SSRI1.133(3FA),(EPA)(DHA),PeetEPA,,1g/dEPAPuriEPA,,EPA,,,,DHAPeet,3PUFA(3)DHAHibbelnDHA,3FA(DHA)5HT,DHA,3FA1.14(antidepressantaugmentor),,,[14,15][16,17],1572008212JournalofPsychiatry,2008,Vol21,No.21.15[18][19]G[20][21][22]B12[23],22.1,,CRHCRH1GABA,,,,2.2[24],,,2.3,,,,,2.4[25],:,22%~26%;,6%;,5%~10%,;,,,,2.5,[26],,,,,,[27]33.1(ECT)ECT,(MECT),,MECT;,ECT;ECT,3.2,80,[28],,3.3,(MT)[29],(SAD)MTMT,,MT,MTNSD()SAD,NSD,Kripke(1992)Yamada(1995)MT,HPA3.4(TranscranialMagneticStimulation,TMS)90,,ECT,rTMS(TMS)rTMS[30]TMSECT,,rTMSECT41582008212JournalofPsychiatry,2008,Vol21,No.24.1[31],,,,,,,,4.2:;;,[32]4.3MiklowitzDJ[33],,502,,,,,[34~35]4.4[36](introspection)3,,,,,,,,,1MurrayCJL.LopezAD.TheGlobalBurdenofDisease:AcomprehensiveassessmentofCambridge(USA)[M].HarvarvardUniversityPress,1996:412-417,445-448,553-556,808-8112Woelk:ComparisonofStJohnswortandimpraminefortreatingdepression:randomizedtrial[J].BrMedJ,2000,321(7260):5363GuoqiangX,ChavkoM,ZhangLX,etal.DecreasedcalciumdependentconstitutivenitricoxidesynthaseactivityinprefrontalcortexinSchizophreniaanddepression[J].SchizophreniaResearch,2000,58:21-304BersteinHG,StanariusA,BaumannB,etal.Nitricoxidesynthase-containingneuronsinthehumanhypothalamus:Reducednumberofimmunoreactivecellsintheparaventricularnucleusofdepressivepatientsandschizophrenics[J].Neuroscience,1998,83(3):867-8755JanGC,VanAmsterdam,OpperhuizenA.Nitricoxideandbioperterinindepressionandstress[J].PsychiatryResearch,1999,85:33-386SuzukiE,YagiG.Elavateplasmanitratelevelsindepressivestates[J].JAffectivedisorders,2001,63:221-2247AndrewJH,KarenHB,BrandyC,etal.Nitricoxidesynthaseinhibitorshaveantidepressantlikepropertiesinmice1.Acutetreatmentsareactiveintheforcedswimtest[J].EuropeanJPharmacology,1999,372:207-2138BeataK,KarenHB,BuyeanL,etal.Nitricoxidesynthaseinhibitorshaveantidepressantlikepropertiesinmice2.Chronictreatmentresultsindownregulationofcorticaladrenoceptors[J].EuropeanJPharmacology,1999,32:215-2209.[J].,1999,26(4):227-22910NemeroffCB,EvansDL,GyillaiL,etal.Doubleblind,placebocontrolledcomparisonofimipramineandparexetineinthetreatmentofbipolardepression[J].AmJPsychiatry,2001,158:906-91211AmericanPsychiatricAssociation.PracticeGuidelineforthetreatmentofPatientswithbipolardisorder[J].AmJPsychiatry,1994,151(suppl12):1-3612TondoL,BaldessariniRJ.Reducedsuicideriskduringlithiummaintenancetreatment[J].JClinPsychiatry,2000,61(suppl9):97-10413,,.[J].,2006,15(10):88214,,.[J].,2002,29(1):48-5015,,.[J].,2005,17(5):268-27016,,,.[J].,2006,19(2):87-8917,,.[J].NervousDiseasesandMentalHygiene,2004,4(2):11218,.[J].,2005,20(1):48-4919,,.[J].1592008212JournalofPsychiatry,2008,Vol21,No.2,1999,26(3):134-13820,,,.[J].,2006,19(1):73-7521.G[J].,1998,25(4):223-22822,.[J].,2006,33(1):45-4723.[J].,2004,31(1):51-5324,,,.B12[J].,2006,19(2):101-10225,,,.[J].,2003,22(5):53-5426,,.[J].,2006,15(8):704-70627,.kappa[J].,2003,13:32-3328,,,.[J].,2006,15(10):91129,.[J].,2004,16(1):36-3830,,.[J].,1998,25(1):1-531GershonAA,DannonPN,GrunhausL.Transcranialmagneticstimulationinthetreatmentofdepression[J].AmJPsychiatry,2003,160(5):835-84532VietaE,ColomF.Psychologicalinterventioninbipolardisorder:fromwishfulthinkingtoanevidencebasedapproach[J].ActaPsychiatrScand,Suppl,2004,422:34-3833ScottJ,GarlandA,MoorheadS.Apilotstudyofcognitivetherapyinbipolardisorder[J].PsycholMed,2001,31:459-46734MiklowitzDJ,RichardsJA,GeorgeEL,etal.Integratedfamilyandindividualtherapyforbipolardisorder:resultofatreatmentdevelopmentstudy[J].JClinPsychiatry,2003,64:182-19135,.[J].,2006,19(3):224-22736.[J].,2005,17:372-374(收稿日期:20071214)(上接第149页)320,,,1Bettelheim,B.Theemptyfortress[M].NewYork:FreePress,1967,3532.[M].:,20053.[J].,2001,24:249-2504BaronCohen,S,Leslie,A.M.,Frith,U.Doestheautisticchildhaveatheoryofmind[J]?Cognition,1985,21:37-465Jolliffe,T,Baron-Cohen,S,Atestofcentralcoherencetheory;linguisticprocessinginhighfunctioningadultswithautismorAspergersyndrome:islocalcoherenceimpaired[J]?Cognition,1999,71:149-1856Harris,N.S,Courchesne,E,Townsend,J,Carper,R.A,Lord,C.Neuroanatomiccontributionstoslowedorientingofattentioninchildrenwithautism[J].Cognitivebrainresearch,1999,8:61-717,,.[J].,2003,39:76-808Loveland,K,Socialaffordancesandinteraction:Autismandtheaffordancesofthehumanenvironment[J].EcologicalPsychology,1991,3:99-1199,.[J].,2005,65:64-70(收稿日期:20071031)1602008212JournalofPsychiatry,2008,Vol21,No.2