НАСЛІДКИ Запропонованої класифікації

Важливим наслідком є те, що бали симптомів окремо (наприклад, PHQ-9) не слід використовувати для визначення наявності або відсутності депресивного розладу, хоча це є важливою частиною оцінки. Оцінка за оціночною шкалою або запитальником може сприяти оцінці депресії і оціночні шкали також корисні для моніторингу прогресу лікування.

Ще один дуже важливий момент полягає в тому, що встановлення діагнозу депресії не означає автоматичне призначення специфічного лікування. Встановлення та узгодження діагнозу депресії є відправною точкою при розгляді найбільш належного способу допомоги людині в конкретних обставинах. Доказова база з лікування, розглянута в даній настанові, в основному базується на РКВ, в яких стандартизовані критерії були використані для визначення включення у випробування. Пацієнти, які спостерігалися клінічно, рідко оцінювалися за допомогою стандартних критеріїв, що підкреслює необхідність більш жорсткої екстраполяції РКВ в клінічній практиці.

Діагностика з використанням тяжкості, тривалості і перебігу (див. вище) обов'язково дає тільки частковий опис індивідуального досвіду депресії. люди з депресією відрізняються за симптомами, сімейною історією, особистістю, труднощі в минулому (наприклад, сексуальне насильство), психологічне мислення і теперішні проблеми в стосунках і соціальні проблеми – всі з яких можуть значно впливати на результати. Крім того, люди з депресією мають супутні психіатричні діагнози, такі як тривога, соціальні фобії, паніка і різні розлади особистості (Braun et al., 2001), і супутні соматичні захворювання, а також депресія буває в контексті біполярного розладу (не розглядається в цій настанові). Стать і соціально-економічні фактори дають великі варіації в популяційних показниках депресії і кілька досліджень медикаментозного, психологічного та інших методів лікування депресії розглядають ці зміни. Це підкреслює, що вибір методу лікування являє собою складний процес і включає в узгодження і обговорення з пацієнтами. Враховуючи обмежені знання про те, які фактори пов'язані з кращими антидепресантами або відповіддю на психотерапію, більшість рішень буде спиратися на клінічну оцінку і переваги пацієнта, поки не з’являться подальші докази з досліджень. Пробне лікування у неясних випадках може бути виправдане, але невизначеність повинна обговорюватися з пацієнтом і користь від лікування ретельно контролюватися.

Таблиця 146 Рівні депресії за HRSD BDI в оновленій настанові порівняно з рівнями за АРА (2002а)

Шкала оцінок депресії Гамільтона HRSD
Оновлена настанова	Немає депресії	Підпорогова	Легка	Помірна	Важка
АРА (2000а)*	Немає депресії	Легка	Помірна	Важка	Дуже важка
Бали	0-7	8-13	14-18	19-22	+23
Шкала депресії Бека (BDI)
	Немає депресії	Підпорогова	Легка до помірної	Помірна до важкої
АРА (2000а)*	Немає депресії	Легка	Помірна	Важка
Бали	0-9	10-16	17-29	+30

* Використовувались у попередній настанові

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