\u3010\u6587\u732e\u3011
\nInitial treatment of depression in adults\u3002UpToDate ONLINE18.1<\/p>\n
\u3010\u8981\u7d04\u3011
\n\u7dcf\u8ad6\u3000
\n\u6297\u3046\u3064\u85ac\u306e\u8a66\u9a13\u306e\u6587\u732e\u3092\u8a55\u4fa1\u3059\u308b\u3068\u304d\u306b\u306f\u3001Publication bias\u3092\u8003\u616e\u3057\u306a\u3051\u308c\u3070\u306a\u3089\u306a\u3044\u3002(\u653f\u5e9c\u307e\u305f\u306f\u72ec\u7acb\u3057\u305f\u30b9\u30dd\u30f3\u30b5\u30fc\u304c\u308f\u305a\u304b\u3067\u3001\u88fd\u85ac\u4f1a\u793e\u3068\u51fa\u6240\u4e0d\u660e\u304c\u591a\u3044\u3002)<\/p>\n
\u85ac\u306e\u9078\u629e\u3000
\n\u30fb\u307b\u3068\u3093\u3069\u306e\u30b7\u30b9\u30c6\u30de\u30c6\u30a3\u30c3\u30af\u30ec\u30d3\u30e5\u30fc\u306b\u304a\u3044\u3066\u7d50\u8ad6\u3065\u3051\u3089\u308c\u3066\u3044\u308b\u3053\u3068\u306b\u306f\u3001\u81e8\u5e8a\u7684\u306b\u3082QOL\u306b\u304a\u3044\u3066\u3082\u3001\u6cbb\u7642\u30b3\u30b9\u30c8\u306b\u3064\u3044\u3066\u3082\u3001\u7279\u5b9a\u306e\u6297\u3046\u3064\u85ac\u306e\u306a\u304b\u3067\u3001\u3069\u308c\u3092\u7279\u5225\u9078\u3076\u3079\u304d\u304b\u3068\u3044\u3046\u3053\u3068\u306f\u306a\u3044\u3002
\n\u30fb\u4f55\u306e\u85ac\u3092\u4f7f\u3046\u304b\u3068\u3044\u3046\u3053\u3068\u3088\u308a\u3082\u3001\u60a3\u8005\u304c\u53d7\u3051\u5165\u308c\u3089\u308c\u308b\u85ac\u3092\u4f7f\u3063\u3066\u6cbb\u7642\u3059\u308b\u3053\u3068\u3068\u3001\u75c7\u72b6\u3092\u5bdb\u89e3\u3055\u305b\u308b\u306e\u306b\u5341\u5206\u306a\u5bb9\u91cf\u3092\u4f7f\u7528\u3059\u308b\u3068\u3044\u3046\u3053\u3068\u306e\u307b\u3046\u304c\u3001\u91cd\u8981\u3067\u3042\u308b\u3002
\n\u30fbSSRI\uff53\u304c\u30d7\u30e9\u30a4\u30de\u30ea\u30b1\u30a2\u3067\u306f\u3057\u3070\u3057\u3070\u7b2c\u4e00\u9078\u629e\u3068\u3057\u3066\u4f7f\u308f\u308c\u3066\u3044\u308b\u7406\u7531\u3068\u3057\u3066\u306f\u3001\u526f\u4f5c\u7528\u304c\u5c11\u306a\u304f\u3001\u904e\u91cf\u6295\u4e0e\u3067\u3082\u3001\u5371\u967a\u304c\u5c11\u306a\u3044\u70b9\u3067\u3042\u308b\u3002<\/p>\n
the American College of Physicians (ACP)\u304b\u3089\u306e2008\u5e74\u81e8\u5e8a\u8a3a\u7642\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u3067\u306f\u3001\u4ee5\u4e0b\u306e12\u306e\u7b2c\u4e8c\u4e16\u4ee3\u6297\u3046\u3064\u85ac\u304b\u3089\u6cbb\u7642\u3092\u958b\u59cb\u3059\u308b\u3053\u3068\u3092\u5f37\u304f\u52e7\u3081\u3066\u3044\u308b\u3002<\/p>\n
\u30d6\u30d7\u30ed\u30d4\u30aa\u30f3bupropion\uff08NDRI;\u30a6\u30a7\u30eb\u30d6\u30c8\u30ea\u30f3\uff09 \u56fd\u5185\u672a
\n\u30b7\u30bf\u30ed\u30d7\u30e9\u30e0citalopram\uff08SSRI\uff1b\u30bb\u30ec\u30af\u30b5\uff09\u3000\u56fd\u5185\u672a
\n\u30c7\u30e5\u30ed\u30ad\u30bb\u30c1\u30f3duloxetine\uff08SNRI\uff1b\u65b0\u2606\u30b5\u30a4\u30f3\u30d0\u30eb\u30bf\u30ab\u30d7\u30bb\u30eb\uff09
\n\uff0a\u4e00\u65e5\u4e00\u56de\u6295\u4e0e\u306e\u30bb\u30ed\u30c8\u30cb\u30f3\u30fb\u30ce\u30eb\u30a2\u30c9\u30ec\u30ca\u30ea\u30f3\u518d\u53d6\u308a\u8fbc\u307f\u963b\u5bb3\u85ac
\n\u30a8\u30b7\u30bf\u30ed\u30d7\u30e9\u30e0escitalopram\uff08SSRI\uff1b\u30ec\u30af\u30b5\u30d7\u30ed\uff09\u3000\u56fd\u5185\u672a
\n\u30d5\u30eb\u30aa\u30ad\u30bb\u30c1\u30f3 fluoxetine\uff08SSRI\uff1b\u30d7\u30ed\u30b6\u30c3\u30af\uff09\u3000\u56fd\u5185\u672a
\n\u30d5\u30eb\u30dc\u30ad\u30b5\u30df\u30f3fluvoxamine(SSRI\uff1b\u30c7\u30d7\u30ed\u30e1\u30fc\u30eb\u3001\u30eb\u30dc\u30c3\u30af\u30b9)
\n\u30df\u30eb\u30bf\u30b6\u30d4\u30f3 mirtazapine \uff08NaSSa\uff1b\u65b0\u2606\u30ec\u30e1\u30ed\u30f3\u3001\u30ea\u30d5\u30ec\u30c3\u30af\u30b9\uff09
\n\uff0a\u30ce\u30eb\u30a2\u30c9\u30ec\u30ca\u30ea\u30f3\u30fb\u30bb\u30ed\u30c8\u30cb\u30f3\u4f5c\u52d5\u6027\u6297\u3046\u3064\u85ac
\n\u30cd\u30d5\u30a1\u30be\u30c9\u30f3nefazodone\uff08SNRI\uff1b\u30b5\u30fc\u30be\u30fc\u30f3\uff09\u3000\u56fd\u5185\u672a
\n\u30d1\u30ed\u30ad\u30bb\u30c1\u30f3paroxetine\uff08SSRI\uff1b\u30d1\u30ad\u30b7\u30eb\uff09
\n\u30bb\u30eb\u30c8\u30e9\u30ea\u30f3 sertraline\uff08SSRI\uff1b\u30b8\u30a7\u30a4\u30be\u30ed\u30d5\u30c8\uff09
\n\u30c8\u30e9\u30be\u30c9\u30f3trazodone\uff08SARI\uff1b\u30c7\u30b8\u30ec\u30eb\uff0c\u30ec\u30b9\u30ea\u30f3\uff09
\n\u30f4\u30a7\u30f3\u30e9\u30d5\u30a1\u30ad\u30b7\u30f3 venlafaxine\uff08SNRI\uff1b\u30a8\u30d5\u30a7\u30af\u30b5\u30fc\uff09\u3000\u56fd\u5185\u672a
\n\u2606\u30cd\u30d5\u30a1\u30be\u30c9\u30f3nefazodone\uff08SNRI\uff1b\u30b5\u30fc\u30be\u30fc\u30f3\uff09\u306b\u306f\u809d\u7d30\u80de\u6bd2\u6027\u3042\u308a<\/p>\n
\u30fb\u904e\u53bb\u306b\u53d7\u3051\u5165\u308c\u306e\u826f\u3044\u85ac\u3067\u6cbb\u7642\u306b\u6210\u529f\u3057\u305f\u60a3\u8005\u306f\u3001\u3046\u3064\u75c5\u304c\u518d\u767a\u3057\u305f\u969b\u306b\u306f\u3001\u540c\u3058\u85ac\u3092\u518d\u958b\u3059\u3079\u304d\u3067\u3042\u308b\u3002
\n\u30fb\u85ac\u306e\u9078\u629e\u306e\u969b\u306b\u306f\u3001\u81e8\u5e8a\u533b\u306e\u4f7f\u3044\u3084\u3059\u3055\uff08\u6163\u308c\u5177\u5408\uff09\u3001\u4fa1\u683c\u3001\u597d\u307f\u3068\u526f\u4f5c\u7528\u3092\u8003\u616e\u3059\u3079\u304d\u3067\u3042\u308b\u3002<\/p>\n
\u526f\u4f5c\u7528
\n\u30fb\u7b2c\u4e8c\u4e16\u4ee3\u3092\u8a55\u4fa1\u3057\u305f203\u306e\u8a66\u9a13\u306e\u30b7\u30b9\u30c6\u30de\u30c6\u30a3\u30c3\u30af\u30ec\u30d3\u30e5\u30fc\u3067\u306fmirtazapine and paroxetine\u304c\u4ed6\u306e\u7b2c\u4e8c\u4e16\u4ee3\u6297\u3046\u3064\u85ac\u306b\u6bd4\u3079\u3066\u3001\u4f53\u91cd\u5897\u52a0\u304c\u304a\u3053\u308a\u3084\u3059\u3044\u3002
\n\u30fb \u3046\u3064\u75c5\u81ea\u4f53\u304c\u3001\u7cd6\u5c3f\u75c5\u3092\u9032\u5c55\u3055\u305b\u308b\u30ea\u30b9\u30af\u8981\u56e0\u3067\u3042\u308b\u300265\u6b73\u4ee5\u4e0a\u306e1000\u4eba\u309210\u5e74\u8ffd\u8de1\u3057\u305f\u524d\u5411\u304d\u7814\u7a76\u3067\u306f\u3001\u3046\u3064\u75c5\u306e\u4eba\u306f\u3001\u6297\u3046\u3064\u85ac\u306b\u3088\u308b\u6cbb\u7642\u306b\u95a2\u308f\u3089 \u305a\u3001\u3046\u3064\u75c5\u3092\u6301\u305f\u306a\u3044\u4eba\u306b\u6bd4\u3079\u30662\u500d\u4ee5\u4e0a\u7cd6\u5c3f\u75c5\u306b\u7f79\u60a3\u3059\u308b\u7387\u304c\u9ad8\u304b\u3063\u305f\u3002(hazard ratio 2.3, 95% CI 1.3-4.1)\u3000
\n\u30fb \u30b1\u30fc\u30b9\u30b3\u30f3\u30c8\u30ed\u30fc\u30eb\u8a66\u9a13\u306b\u304a\u3044\u3066\u3001\u3046\u3064\u304c\u3042\u308a\u3001\u7cd6\u5c3f\u75c5\u304c\u306a\u3044\u304a\u3088\u305d166,000\u4eba\u306e\u60a3\u8005\u306e\u3046\u3061\u3001\u6297\u3046\u3064\u85ac\u306e\u4e2d\u7b49\u91cf\uff5e\u9ad8\u7528\u91cf\u306e\u9577\u671f\u9593\uff082\u5e74\u4ee5\u4e0a\uff09\u306e\u4f7f\u7528 \u304c\u3001\u9855\u8457\u306b\u7cd6\u5c3f\u75c5\u306e\u30ea\u30b9\u30af\u5897\u306b\u95a2\u4fc2\u3057\u305f\u3002(incidence rate ratio 1.8, 95% CI 1.4-2.5)
\n\u7cd6\u5c3f\u75c5\u306e\u30ea\u30b9\u30af \u5897\u52a0\u306e\u898b\u7a4d\u3082\u308a\u306f\u3001amitriptyline (incidence rate ratio: 1.43, 1.03-1.98), fluvoxamine (incidence rate ratio: 4.91, 1.05-23.03), paroxetine (incidence rate ratio: 1.33, 1.02-1.73), and venlafaxine (incidence rate ratio: 2.03, 1.18-3.48)
\n\u30fb\u4ed6\u306e\u526f\u4f5c\u7528\u306b\u3064\u3044\u3066\u306f\u4e00\u822c\u7684\u306a\u5185\u5bb9\u3067\u3042\u3063\u305f\u306e\u3067\u5272\u611b\u3002<\/p>\n
\u7528\u91cf
\n\u30fb\u5c11\u91cf\u304b\u3089\u958b\u59cb\u3059\u308b\u3053\u3068\u3067\u3001\u6297\u3046\u3064\u85ac\u306e\u526f\u4f5c\u7528\u3092\u6700\u5c0f\u9650\u306b\u3059\u308b\u3053\u3068\u304c\u3067\u304d\u308b\u3002
\n\u30fb\u4e00\u9031\u9593\u3054\u3068\u306b\u6700\u5927\u91cf\u307e\u3067\u6f38\u5897\u3059\u308b\u3002
\n\u30fb\u85ac\u306f\u305f\u3044\u3066\u3044\u671d\u306b\u5185\u670d\u3059\u308b\u3002\u5185\u670d\u5f8c\u30018\u6642\u9593\u304b\u308912\u6642\u9593\u306f\u7a4f\u3084\u304b\u306a\u8208\u596e\u4f5c\u7528\u304c\u3042\u308a\u3001\u7720\u308a\u3092\u963b\u5bb3\u3059\u308b\u53ef\u80fd\u6027\u304c\u3042\u308b\u3002
\n\u30fbSSRI\u306f\u3001\u5bdb\u89e3\u3092\u9054\u6210\u3059\u308b\u305f\u3081\u306b\u306f\u5178\u578b\u91cf\u3088\u308a\u9ad8\u7528\u91cf\u3092\u5fc5\u8981\u3068\u3059\u308b\u3002
\n\u30fb\u4e09\u74b0\u5f62\u6297\u3046\u3064\u85ac\u306f\u3001\u3088\u308a\u5c11\u91cf\u3067\u3082\u9ad8\u5bb9\u91cf\u3068\u540c\u7a0b\u5ea6\u306b\u52b9\u679c\u304c\u3042\u308b\u3088\u3046\u3059\u3002<\/p>\n
\u30d5\u30a9\u30ed\u30fc\u30a2\u30c3\u30d7
\n\u30fb\u6cbb\u7642\u958b\u59cb\u304b\u3089\u6cbb\u7642\u306b\u53cd\u5fdc\u3059\u308b\u307e\u3067\u306e\u6642\u9593\u306f2\u9031\u9593\u304b\u30896\u9031\u9593\u3068\u8003\u3048\u3089\u308c\u3066\u3044\u308b\u3002
\n\u30fb\u3042\u308b\u8a66\u9a13\u3067\u306f\u6cbb\u7642\u958b\u59cb\u304b\u3089\uff12\u9031\u9593\u4ee5\u5185\u306e\u65e9\u3044\u53cd\u5fdc\u306f\u3001\u6cbb\u7642\u306e\u5b89\u5b9a\u3057\u305f\u52b9\u679c\u3068\u5bdb\u89e3\u306e\u7d99\u7d9a\u3092\u4e88\u6e2c\u3055\u305b\u308b\u3002
\n\u30fb\uff12\u9031\u9593\u904e\u304e\u3066\u3082\u53cd\u5fdc\u304c\u306a\u3044\u5834\u5408\u3001\u85ac\u306e\u91cf\u3092\u5897\u91cf\u3057\u306a\u3051\u308c\u3070\u306a\u3089\u306a\u3044\u3002
\n\u30fb\u6700\u5927\u91cf\u3067\uff18\uff5e\uff11\uff10\u9031\u9593\u7d4c\u904e\u3057\u3066\u3082\u53cd\u5fdc\u304c\u306a\u3044\u5834\u5408\u306f\u3001\u7570\u306a\u308b\u6297\u3046\u3064\u85ac\uff08\u540c\u3058\u307e\u305f\u306f\u7570\u306a\u3063\u305f\u30af\u30e9\u30b9\u306e\uff09\u3092\u8a66\u3059\u304b\u3001\u7cbe\u795e\u79d1\u306b\u7d39\u4ecb\u3057\u306a\u3051\u308c\u3070\u306a\u3089\u306a\u3044\u3002
\n\u30fb\u90e8\u5206\u7684\u306a\u53cd\u5fdc\u306e\u5834\u5408\u306f\u3001bupropion\uff08\u56fd\u5185\u672a\uff09 or buspirone\uff08\u56fd\u5185\u672a\uff09\u3092\u8ffd\u52a0\u3059\u308b\u304b\u3001\u60a3\u8005\u304c\u85ac\u306e\u8ffd\u52a0\u3092\u597d\u307e\u306a\u3051\u308c\u3070\u3001\u4ed6\u306eSSRI\u3001SNRI\u306b\u63db\u3048\u308b\u3002
\n\u6cbb\u7642\u671f\u9593
\n\u30fb\u6297\u3046\u3064\u85ac\u306f\u4e00\u822c\u7684\u306b\u3001\u6700\u521d\u306e\u3046\u3064\u306e\u30a8\u30d4\u30bd\u30fc\u30c9\u5f8c\u3001\u6700\u77ed\u3067\u3082\uff16\uff0d\uff19\u30f6\u6708\u5185\u670d\u3057\u306a\u3051\u308c\u3070\u306a\u3089\u306a\u3044\u3002
\n\u30fb\u60a3\u8005\u306b\u3088\u308b\u85ac\u306e\u4e2d\u65ad\u306f\u591a\u3044\u3002
\n\u30fb\u518d\u767a\u3082\u591a\u3044\u3002\u7279\u306b3\u56de\u4ee5\u4e0a\u7e70\u308a\u8fd4\u3057\u3066\u3044\u308b\u4f8b\u306f\u85ac\u306e\u7d99\u7d9a\u304c\u671b\u307e\u3057\u3044\u3002<\/p>\n
\u7cbe\u795e\u79d1\u3078\u7d39\u4ecb\u3059\u308b\u30b1\u30fc\u30b9
\n\u30fb\u30d5\u30a1\u30fc\u30b9\u30c8\u30e9\u30a4\u30f3\u306e\u85ac\u3092\u60a3\u8005\u304c\u53d7\u3051\u5165\u308c\u3089\u308c\u306a\u3044\u3001\u307e\u305f\u306f\u52b9\u679c\u304c\u306a\u3044\u5834\u5408
\n\u30fb\u601d\u8003\u969c\u5bb3\u3092\u4f34\u3063\u305f\u91cd\u75c7\u306a\u3046\u3064\u304b\u3001\u81ea\u6bba\u885d\u52d5\u304c\u3042\u308b\u5834\u5408
\n\u30fb\u85ac\u54c1\u4e2d\u6bd2\u3084\u7cbe\u795e\u4f9d\u5b58\u3001\u85ac\u7269\u4e71\u7528\u3092\u4f34\u3063\u3066\u3044\u308b\u5834\u5408
\n\u30fb\u60a3\u8005\u304c\u8a8d\u77e5\u884c\u52d5\u7642\u6cd5\u3092\u5f37\u304f\u671b\u3093\u3067\u3044\u308b\u5834\u5408<\/p>\n
\u3010\u65e5\u4ed8\u3011
\n\uff12\uff10\uff11\uff10\u5e74\uff17\u6708\uff11\uff14\u65e5\uff08\u6c34\uff09<\/p>\n","protected":false},"excerpt":{"rendered":"
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