Differential responses to psychotherapy versus pharmacotherapy in patients with chronic forms of major depression and childhood trauma
Differential responses to psychotherapy versus pharmacotherapy in patients with chronic forms of major depression and childhood trauma
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DOI：
10.1073/pnas.2336126100
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发表时间：
2003-11-25
影响因子：
11.1
通讯作者：
Keller, MB
中科院分区：
文献类型：
--
作者：
Nemeroff, CB;Heim, CM;Keller, MB
重度抑郁症与相当高的发病率、残疾和自杀风险相关。治疗抑郁症最常见的方法包括抗抑郁药、心理治疗或两者结合。我们对抑郁症治疗反应的预测因素知之甚少。在这项研究中，681名慢性重度抑郁症患者接受抗抑郁药（奈法唑酮）、心理治疗认知行为分析系统（CBASP）或两者联合治疗。总的来说，单独使用抗抑郁药和单独使用心理治疗的效果是相同的，而且明显低于联合治疗。在那些有童年早期创伤史（幼年失去父母，身体或性虐待，或忽视）的患者中，单独的心理治疗优于单药抗抑郁治疗。此外，在儿童虐待队列中，心理治疗和药物治疗的结合仅略优于单独的心理治疗。我们的研究结果表明，心理治疗可能是治疗慢性重度抑郁症和童年创伤史患者的基本要素。
Major depressive disorder is associated with considerable morbidity, disability, and risk for suicide. Treatments for depression most commonly include antidepressants, psychotherapy, or the combination. Little is known about predictors of treatment response for depression. In this study, 681 patients with chronic forms of major depression were treated with an antidepressant (nefazodone), Cognitive Behavioral Analysis System of Psychotherapy (CBASP), or the combination. Overall, the effects of the antidepressant alone and psychotherapy alone were equal and significantly less effective than combination treatment. Among those with a history of early childhood trauma (loss of parents at an early age, physical or sexual abuse, or neglect), psychotherapy alone was superior to antidepressant monotherapy. Moreover, the combination of psychotherapy and pharmacotherapy was only marginally superior to psychotherapy alone among the childhood abuse cohort. Our results suggest that psychotherapy may be an essential element in the treatment of patients with chronic forms of major depression and a history of childhood trauma.