The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: a meta-analysis of direct comparisons
The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: a meta-analysis of direct comparisons
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DOI：
10.1002/wps.20038
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发表时间：
2013-06-01
期刊：
影响因子：
73.3
通讯作者：
Reynolds, Charles F., III
中科院分区：
文献类型：
--
作者：
Cuijpers, Pim;Sijbrandij, Marit;Reynolds, Charles F., III
虽然心理治疗和抗抑郁药物在治疗抑郁症和焦虑症方面都有效，但目前还不清楚它们对所有类型的障碍是否同样有效，以及是否所有类型的心理治疗和抗抑郁药物对每种疾病都同样有效。我们对心理治疗和抗抑郁药物在治疗抑郁症和焦虑症方面进行了直接比较的研究进行了荟萃分析。在书目数据库中的系统搜索产生了67项随机试验，包括5993名符合纳入标准的患者，40项专注于抑郁障碍的研究，27项专注于焦虑症的研究。表明心理治疗和药物治疗在所有疾病治疗后的差异的总体效应大小为g=0.02(95%CI：-0.07~0.10)，无统计学意义。药物疗法对恶劣心境障碍的疗效显著高于心理疗法(g=0.30)，而心理疗法对强迫症的疗效显著高于药物疗法(g=0.64)。此外，药物治疗的有效率显著高于非指导性咨询(g=0.33)，心理治疗的有效率显著高于三环类抗抑郁药的药物治疗(g=0.21)。当我们在多变量Meta回归分析中控制研究的其他特征时，这些结果仍然显著，除了恶劣心境的不同影响，这不再具有统计学意义。
Although psychotherapy and antidepressant medication are efficacious in the treatment of depressive and anxiety disorders, it is not known whether they are equally efficacious for all types of disorders, and whether all types of psychotherapy and antidepressants are equally efficacious for each disorder. We conducted a meta-analysis of studies in which psychotherapy and antidepressant medication were directly compared in the treatment of depressive and anxiety disorders. Systematic searches in bibliographical databases resulted in 67 randomized trials, including 5,993 patients that met inclusion criteria, 40 studies focusing on depressive disorders and 27 focusing on anxiety disorders. The overall effect size indicating the difference between psychotherapy and pharmacotherapy after treatment in all disorders was g=0.02 (95% CI: -0.07 to 0.10), which was not statistically significant. Pharmacotherapy was significantly more efficacious than psychotherapy in dysthymia (g=0.30), and psychotherapy was significantly more efficacious than pharmacotherapy in obsessive-compulsive disorder (g=0.64). Furthermore, pharmacotherapy was significantly more efficacious than non-directive counseling (g=0.33), and psychotherapy was significantly more efficacious than pharmacotherapy with tricyclic antidepressants (g=0.21). These results remained significant when we controlled for other characteristics of the studies in multivariate meta-regression analysis, except for the differential effects in dysthymia, which were no longer statistically significant.