精神医学63巻11号

2021年11月発行

特集 「実感と納得」に向けた病気と治療の伝え方

うつ病

著者： 渡邊衡一郎¹

所属機関： ¹杏林大学医学部精神神経科学教室

ページ範囲：P.1587 - P.1595

抄録　うつ病治療の成功のためには，「当事者が治療者を信頼する」ことが前提となる。気分障害の当事者は，あらゆる疾患の中で最も治療者を信頼していると言われ，その当事者の信頼にいかに応えるかが治療の成否を分かつと考える。共同意思決定(SDM)は，治療選択肢の多い精神疾患の治療に適している。良好なコミュニケーションに基づき，当事者に「治療者が親身にかかわってくれている」というプラスの印象を与えやすい。わが国でも，初診時にSDMを導入することで，会話が活発になり，決定に対する自信も高くなった。また，治療上新しい局面を迎える際にもSDMの活用が望ましい。SDMは治療者の治療に対する考えや姿勢を表すものと言い換えることができ，そのことが当事者の実感と納得に繋がり，治療成功に繋がるものと考える。

参考文献

1)Kato M, Hori H, Inoue T, et al：Discontinuation of antidepressants after remission with antidepressant medication in major depressive disorder：a systematic review and meta-analysis. Mol Psychiatry 26：118-133, 2020

2)Sawada N, Uchida H, Suzuki T, et al：Persistence and compliance to antidepressant treatment in patients with depression：a chart review. BMC Psychiatry 9：38, 2009

3)Sawada N, Uchida H, Watanabe K, et al：How successful are physicians in eliciting the truth from their patients? A large-scale Internet survey from patients' perspectives. J Clin Psychiatry 73：311-317, 2012

4)Dunlop BW, Kelley ME, Aponte-Rivera V, et al：Effects of patient preferences on outcomes in the Predictors of Remission in Depression to Individual and Combined Treatments(PReDICT)Study. Am J Psychiatry 174：546-556, 2017

5)van Schaik DJ, Klijn AF, van Hout HP, et al：Patients' preferences in the treatment of depressive disorder in primary care. Gen Hosp Psychiatry 26：184-189, 2004

6)Serretti A, Chiesa A：Treatment-emergent sexual disfuntion related to antidepressants. A meta-analysis. J Clin Psychopharmacol 29：259-266, 2009

7)Price J, Cole V, Goodwin GM：Emotional side-effects of selective serotonin reuptake inhibitors qualitative study. Br J Psychiatry 195：211-217, 2009

8)Minamisawa A, Suzuki T, Watanabe K, et al：Patient's trust in their psychiatrist a cross-sectional survey. J Affect Disord 261：603-608, 2011

9)Matthews EB, Savoy M, Paranjape A, et al：Shared decision making in primary care based depression treatment, communication and decision-making preferences among an underserved patient population. Front Psychiatry 12：681165, 2021

10)渡邊衡一郎：共同意思決定(SDM)の概念と現状．精神医学 62：1301-1309, 2020

11)Hamann J, Neuner B, Kasper J, et al：Participation preferences of patients with acute and chronic conditions. Health Expectations 10：358-363, 2007

12)Ahmed AO, Marino BA, Rosenthal E, et al：Recovery in schizophrenia, what consumers know and do not know. Psychiatr Clin North Am 39：313-330, 2016

13)日本うつ病学会 気分障害の治療ガイドライン作成委員会：日本うつ病学会治療ガイドラインⅡ．うつ病(DSM-5)/大うつ病性障害．2016　https://www.secretariat.ne.jp/jsmd/iinkai/katsudou/data/20190724.pdf(2021年10月1日閲覧)

14)渡邊衡一郎：精神科領域におけるshared decision makingのこれまでとこれから．精神科 36：411-418, 2020

15)Rush AJ, Thase ME：Improving depression outcome by patient-centered medical management. Am J Psychiatry 175：1187-1198, 2018

16)Solberg LI, Crain AL, Rubenstein L, et al：How much shared decision making occurs in usual primary care of depression. J Am Board Fam Med 27：199-208, 2014

17)Crawford J, Petrie K, Harvey SB：Shared decision-making and the implementation of treatment recommendations for depression. Patient Educ Couns 104：2119-2121, 2021

18)Loh A, Simon D, Wills CE, et al：The effects of a shared decision-making intervention in primary care of depression：a cluster-randomized controlled trial. Patient Educ Couns 67：324-332, 2007

19)LeBlanc A, Herrin J, Williams MD, et al：Shared decision making for antidepressants in primary care：a cluster randomized trial. JAMA Intern Med 175：1761-1770, 2015

20)Légaré F, Adekpedjou R, Stacey D, et al：Interventions for increasing the use of shared decision making by healthcare professionals. Cochrane Database Syst Rev 7：CD006732, 2018

21)Fifer S, Puig A, Sequeira V, et al：Understanding treatment preferences of Australian patients living with treatment-resistant depression. Patient Prefer Adherence 15：1621-1637, 2021

22)Rodenburg-Vandenbussche S, Carlier I, Vliet I, et al：Patients' and clinicians' perspectives on shared decision-making regarding treatment decisions for depression, anxiety disorders, and obsessive-compulsive disorder in specialized psychiatric care. J Eval Clin Pract 26：645-658, 2020

23)Aoki Y, Takaesu Y, Inoue M, et al：Seven-day shared decision making for outpatients with first episode of mood disorders among university students：a randomized controlled trial. Psychiatry Res 281：112531, 2019

24)McAllister-Williams RH, Arango C, Blier P, et al：The identification, assessment and management of difficult-to-treat depression：an international consensus statement. J Affect Disord 267：264-282, 2020

25)Ruberto VL, Jha MK, Murrough JW, et al：Pharmacological treatments for patients with treatment-resistant depression. Pharmaceuticals(Basel)13：116, 2020

26)Jha MK：Discontinuing antidepressants：how can clinicians guide patients and drive research. J Clin Psychiatry 80：19com13047, 2019

27)Khalifeh H, Molyneaux E, Brauer R, et al：Patient decision aids for antidepressant use in pregnancy：a pilot randomized controlled trial in the UK. BJGP Open 3：bjgpopen19X101666, 2019