心療内科におけるうつ病治療の現状と問題点(心身症に対する新しい薬物療法)(第35回日本心身医学会総会)

抄録

Many patients with depression visit at the department of psychosomatic medicine. It is characteristic of these patients that their symptoms are milder than the patients in psychiatry and they have more somatic symptoms than psychological. The therapeutic approach to depression may have to be modified by the patients' psychological status, because the genesis of depression is varied and depression is a heterogeneous disorder. We studied the features of these patients and their therapeutic procedures in our department of psychosomatic medicine. Eighty percent of all first-visit patients had depressive disorders (classified by DSM-III-R), and 30.2% of them were major depression, 11.8% were dysthymia and 58% not otherwise specified (NOS). The severity of depression was milder. The recent general adaptation function (GAF) of major depression was lowest in the three subtypes of depressive disorders, even though the mean GAF score of major depression was 55.4. The comorbidity of somatic disorder shows a high rate. Forty percent of patients with depressive disorders have functional somatic disorders, such as irritable bowel syndrome, migraine, tension type headache, hypertension etc. As to pharmacotherapy, many of the patients with depressive disorders in our department of psychosomatic medicine, received plural drugs such as antidepressant, anxiolytics, sulpiride, hypnotics. Antidepressants were prescribed most frequently in the major depression group. Anxiolytics and sulpiride were used commonly in all groups. As to the reason why anxiolytic and sulpiride were prescribed frequently, we have concluded that these phenomena raised from those usual antidepressants need the long period of time before main effects appear and they have various undesirable side effects. The selective serotonin reuptake inhibitors (SSRIs) are developed and emerging already as a new class of antidepressant in USA and Europe. The SSRIs have equivalent efficacy to standard antidepressant treatment such as the tricyclics, but with improved safety, a more acceptable side-effect profile and reduced risks with overdosage. Treatment expectations will be raised and a broader spectrum of patients will be able to receive treatment.