中文摘要
　　憂鬱症是一個耗費個人和社會成本很高的疾患。臨床上治療方式有藥物、心理治療及電氣痙攣治療或光治療等。其中抗憂鬱劑至少須服藥2-4週以上才有療效，其一個治療的療程至少需6個月時間，以減少再次復發的危險性，然而此類病患的遵醫囑性及回診率都不高。分析此類病患服藥順從性不佳的原因，多半是因為對此類疾病認識不深、因初期使用覺得有療效就停藥及對藥物使用的治療時間長短、副作用等認知不足所致；也是造成憂鬱症反覆發作的主因。目前國外針對於藥師介入憂鬱症治療的研究，多藉由提供藥物資訊及解決用藥相關問題及評估用藥合理性等方式，來促使病患服藥順從性增加，治療成效提升；國內藥師參與憂鬱症治療的研究相當缺乏，所以想經由此研究了解藥師介入成效。

　　本研究分成兩部分。第一部分為前瞻性，隨機分配性研究，探討藉由臨床藥師的介入，提升病患對於疾病與藥物使用的認知，提高憂鬱症治療的效果。其方法於成大醫院精神科初診及複診收集診斷為重度及輕度憂鬱症者為研究對象，共收納初診病患30人，複診病患60人，各分為介入與無介入者為各一半。一組採藥師介入憂鬱症照顧，一組無藥師介入；追蹤三個月，於追蹤過程中由同一位藥師解說憂鬱症相關知識，並給予用藥指導。藥師於診間介入三個月後，觀察到初診與複診病患的藥物知識程度變化，藥師介入組與非介入組間比較達到統計上差異。初診患者於藥師介入後，治療相信度、滿意度、服藥順從性有提升趨勢。

　　第二部分為評估醫師處方抗憂鬱劑考量因素，由於目前所有抗憂鬱劑療效相當，選用原則多依據藥物副作用、耐受性、病患臨床表徵等方面來考量，但臨床上病人常伴有其他因素如焦慮、非典型表徵等，亦會影響藥物選擇。目前研究多著重處方趨勢，少有探索選擇藥物原因，而國內亦少有此方面研究，所以想經由此研究了解醫師臨床思維。其結果顯示，主要考量因素有：病患合併有特殊症狀出現、希望避免藥物的副作用、病患合併有其他疾病，及參考過去就醫經驗等。其中焦慮與失眠為最常被考量的合併有特殊症狀；最被醫師關切希望避免的藥物副作用是胃腸不適。

Abstract
　Major depression is associated with significant costs as well as functional and social disability. Clinical guidelines indicate that patients should take antidepressants for at least 6 months to prevent relapse and recurrence, but early discontinuation and other forms of nonadherence to antidepressant treatment are concerned. However, depressive patients are frequently discontinued because of adverse effects, poor understanding of the regimen, and delayed therapeutic effects. The pharmacist’s role in the management of depression is evolving in USA. Pharmacists may help improve the pharmacological management of depression by patient education, medication selection and appropriate dosing, enhancing medication compliance, monitoring treatment effectiveness, and identifying and managing adverse effects. But the data about pharmacists’ intervention in depressive care in Taiwan are deficient.

　This study was divided into two parts. In the first part, a prospective, randomized study was to examine the effects of pharmacist’s montoring on depressive patients by offering knowledge about antidepressant. Ninty patients with major depression or dysthymia were enrolled and randomized to intervention group or control group. Attitude about antidepressants is increased in all patients of pharmacist intervention group after 3 months. Pharmacists also improve patient satisfaction, and adherence with antidepressant medication therapy, especially for those not on antidepressants at enrollment, although outcome differences were not stastistically significant.

　In the second part of this study, we examined the factors psychiatrists would consider when prescribing antidepressants. The most common factors influencing antidepressant selection were the avoidance of specific side effects, the presence of comorbid psychiatric disorders, the presence of specific clinical symptoms and prior treatment history. Anxiety and insomnia were most frequently reported to influence medication selection. Gastrointestinal upset was the side effects that physicians had the greatest concern upon medication selection.

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