(major depressive disorder)

(depressed mood) (loss of

interest)

10 -15


morbidity mortality

15

(recommendations)

1.
1.1
1.2 mania
1.3
1.4
1.5
1.6 (mental status)
1.7
,
DSM-IV ( 1)

2.

.
2.1
2.2
2.3

2.4
2.5
2.6 (supporting system)
2.7

3.
, systemic disease, hypothyroid
hyperthyroid,

4.
anxiety
disorder, personality disorder
5.
supporting system,
, , , ,

1.

 /



/

2.
2.1 Acute phase
6-8 remission

2.1.1
Selective
Serotonin Reuptake Inhibitor (SSRI), tricylic antidepressant (TCA),
venlafaxine, mirtazepine, bupropion
, ,
,
,
TCA
orthostatic hypotension SSRI
, sexual dysfunction, agitation
2

benzodiazepine benzodiazepine
2.1.2
1. 3
2.

3.
2.1.3
1. (clinical condition)
2. suicidal risk

3. ,
4.
(acute phase)

2.2 Continuation phase 16-20 remission

(relapse)
acute phase 2-4
2.3 Maintenance phase

2.4 Discontinuation

1.
2.
3.
4.
5.
6.

high suicidal risk ( 4)

poor supporting system
(psychotic)
2-4

 1 DSM-IV
A. () 2
(1)
(2)
: moodin-congruent delusions hallucinations
(1)
( ) (
)
:
(2)
(
)
(3)
( 5 )

:
(4)
(5) Psychomotor agitation retardation (
)
(6)
(7) (
) ()
(8)
( )
(9) ()

B. mixed episode
C.

D. ( )
( hypothyroidism)
E. (bereavement)
2

psychomotor retardation

Tricyclic
Amitriptyline
Nortriptyline
SSRI
Escitalopram
Fluoxetine
Fluvoxamine
Paroxetine
Sertraline

Bupropion
Venlafaxine
Mirtazapine

(mg/day)

(mg/day)

25-30
25

100-300
50-200

20
20
50
20
50

20-60
20-60
50-300
20-60
50-200

150
37.5
15

300
75-225
15-45

3
1.
2.
3.

4. 2-4

5.

6.
7.
8.
9.

10.

4 (high suicidal risk)

1. Panic attacks and/or severe psychic anxiety
2. Depressed mood
3. Recent loss by death, divorce or separation
4. Substance abuse
5. Severe hopelessness or helplessness
6. Insomnia
7. Severe anhedonia
8. Previously disorder and/ or physical illness
9. Previously history of suicide attempts
10. Frequent suicidal ideation
11. Concrete suicide plan
12. Family history of suicide
13. Single status
14. Diminished concentration
15. Elderly Caucasian and Asian men over the age of 65 years and Asian woman
over 80 years are at disproportionate risk

Investigation

suicidal risk

DSM-IV

Acute phase
-
-
-

Continuation and maintenance

6- 12

High suicidal risk

Poor supporting system

High suicidal risk

Poor supporting
system


1. . 2544.
: , 2544:47-57.
2. , . DSM-IV
. : , 2539:124-5.
3. American Psychiatric Association. American Psychiatric Association practice
guidelines for the treatment of psychiatric disorders: American Psychiatric press, Inc,
Compendium 2002:463-546.
4. American Psychiatric Association. Quick reference to American Psychiatric
Association practice guidelines for the treatment of psychiatric disorders: American
Psychiatric press, Inc, Compendium 2002:99-120.
5. Institute for Clinical Systems Improvement. Major depression in adults for mental
health care.9th edition. May 2004:1-52.