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治疗精神障碍的药物包括抗精神病药、抗焦虑药和抗抑郁药等。由于抑郁症流行率的不断上升,抗抑郁药的使用也越来越广泛。怎样使用抗抑郁药成为全科医学服务中备受关注的问题。在澳大利亚,全科医生可以给抑郁症患者开各种抗抑郁药,药物选择主要考虑的是病人的年龄和性别、以往使用抗抑郁药的效果、过量使用情况下的安全性以及药物的副作用。在中国的国家基本药物目录中,列入了20余种抗抑郁药,涵盖了抗抑郁药的各种类型,不过该基本药物目录的“基层医疗卫生机构配备使用部分”只规定了2种(阿米替林和多塞平,均属三环类)。抗抑郁药在中国社区卫生服务中的使用,一方面取决于服务能力的考虑(全科医生是否经过比较完善的心理健康培训,并积累较为丰富的临床经验),另一方面取决于政策方面的原因(特别是医疗保险对在基层和社区使用治疗精神障碍药物的规定)。澳大利亚的专家认为经过良好培训的全科医生是可以诊治抑郁症的,他们在这里通过案例讨论了抗抑郁药的使用方法,是中国全科医学培训和研究的一个好教材。
Medications for treating mental disorders include antipsychotics, anti-anxiety medications and antidepressants. As the prevalence of depression continues to rise, the use of antidepressants is also becoming more widespread. How to use antidepressants has become a major concern in general medical services. In Australia, GPs can prescribe a variety of antidepressants to depressed patients. The primary consideration is the patient’s age and gender, the antidepressants used in the past, the safety of overuse, and the side effects of the drug. More than 20 antidepressants have been included in China’s national essential medicines list, covering all types of antidepressants, but only 2 of the Essential Medicines Agency Species (amitriptyline and doxepin, are tricyclic). The use of antidepressants in community health services in China depends on the consideration of service capabilities (whether general practitioners have undergone intensive mental health training and accumulated rich clinical experience) on the one hand, and policy-based Reasons (especially health insurance provisions for the use of psychotropic substances in grassroots and community settings). Australian experts believe that well-trained GPs can treat depression. Here they discuss the use of antidepressants through cases and are a good example of training and research in Chinese general practice.