Antidepressant monotherapy vs sequential pharmacotherapy and mindfulness-based cognitive therapy, or placebo, for relapse prophylaxis in recurrent depression.
Antidepressant monotherapy vs sequential pharmacotherapy and mindfulness-based cognitive therapy, or placebo, for relapse prophylaxis in recurrent depression.
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DOI：
10.1001/archgenpsychiatry.2010.168
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发表时间：
2010-12
影响因子：
--
通讯作者：
Levitan, Robert D.
中科院分区：
文献类型：
--
作者：
Segal, Zindel V.;Bieling, Peter;Young, Trevor;MacQueen, Glenda;Cooke, Robert;Martin, Lawrence;Bloch, Richard;Levitan, Robert D.
基于正念的认知治疗(MBCT)是一种基于群体的心理社会干预，旨在加强对与抑郁复发相关的前驱症状的自我管理。为了比较接受MBCT和维持性抗抑郁药物治疗的缓解抑郁症患者的复发率，将接受算法告知的抗抑郁药物治疗8个月后符合缓解标准的现有护理标准的患者随机分为维持性抗抑郁药物(M-ADM)、MBCT或安慰剂(PLA)，并随访18个月。多伦多成瘾和精神健康中心和汉密尔顿圣约瑟夫医疗保健中心的门诊。160名年龄在18岁至65岁之间的患者符合DSM-IV的严重抑郁障碍标准，至少有2次既往发作。在这些患者中，84人获得缓解(52.5%)，并被分配到3种研究条件之一。缓解的患者要么停止服用抗抑郁药物，参加每周8次的MBCT小组会议，继续服用治疗剂量的抗抑郁药物，要么停止服用安慰剂。复发被定义为至少两周内症状的恢复，足以满足SCID模块A中的严重抑郁标准。意向治疗分析显示，在随机患者中，急性期缓解的质量和随后预防复发之间存在显著的交互作用(p=.03)。在不稳定的缓解期患者(定义为缓解期1个或1个以上的≤>；7)中，MBCT和M-ADM患者的风险与解放军相比降低了73%(p=0.03)，而对于稳定的缓解期患者(缓解期所有HRSD>；7)，两组患者的生存率没有差异。在考虑了过去抑郁发作对复发的影响后，研究结果仍然显著。对于不愿意或不能耐受长期维持性抗抑郁药物治疗的抑郁症患者，MBCT提供了同样的预防复发的保护。
Mindfulness Based Cognitive Therapy (MBCT) is a group-based psychosocial intervention designed to enhance self-management of prodromal symptoms associated with depressive relapse. To compare rates of relapse in remitted depressed patients receiving MBCT against maintenance antidepressant pharmacotherapy, the current standard of care Patients who met remission criteria following 8 months of algorithm informed antidepressant treatment were randomized to either: Maintenance Antidepressant Medication (M-ADM), MBCT or placebo (PLA) and were followed for 18 months. Outpatient clinics at the Centre for Addiction and Mental Health, Toronto and St. Joseph’s Healthcare, Hamilton. One hundred sixty patients aged 18 to 65 meeting DSM-IV for major depressive disorder with a minimum of 2 past episodes. Of these, 84 achieved remission (52.5%) and were assigned to one of the 3 study conditions. Remitted patients either discontinued their antidepressants and attended eight weekly group sessions of MBCT, continued on their therapeutic dose of antidepressant medication or discontinued active medication onto placebo. Relapse was defined as a return, for at least 2 weeks, of symptoms sufficient to meet the criteria for major depression on Module A of the SCID. Intention to treat analyses revealed a significant interaction between the quality of acute phase remission and subsequent prevention of relapse in randomized patients (p = .03). Among unstable remitters (defined as 1 or more HRSD >7 during remission) patients in both MBCT and M-ADM showed a 73% decrease in hazard compared to PLA (p = .03), whereas for stable remitters (all HRSD ≤ 7 during remission) there were no group differences in survival. Findings remained significant after accounting for the effects of past depressive episodes on relapse. For depressed patients who are unwilling or unable to tolerate long term maintenance antidepressant treatment, MBCT offers equivalent protection from relapse.
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