Treatment outcomes for primary care patients with major depression and lifetime anxiety disorders.
Treatment outcomes for primary care patients with major depression and lifetime anxiety disorders.
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DOI：
10.1176/ajp.153.10.1293
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发表时间：
1996-10
期刊：
影响因子：
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通讯作者：
Charlotte Brown;Herbert C. Schulberg;M. J. Madonia;M. Shear;Patricia R. Houck
中科院分区：
文献类型：
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作者：
Charlotte Brown;Herbert C. Schulberg;M. J. Madonia;M. Shear;Patricia R. Houck
在精神科和初级保健患者中，高达60%的重度抑郁症伴发广泛性焦虑障碍和惊恐障碍。在精神病样本中，这种合并症与更严重的抑郁症、更差的心理社会功能和更差的治疗结果相关。本研究探讨了抑郁症的初级保健患者的临床结果，并没有终身焦虑症。方法：共有157名符合抑郁症标准的初级保健患者被随机分配到标准化人际心理治疗或去甲替林药物治疗组，并在基线和4个月和8个月时评估抑郁症的严重程度、心理社会功能和健康相关功能。结果抑郁症患者共病焦虑障碍表现出显着更多的精神病理学和倾向于提前终止治疗的患者比单独的抑郁症。这两种标准化抑郁症特异性治疗对伴有和不伴有共病广泛性焦虑障碍的抑郁症患者都有效，尽管前者的恢复时间较长。终身惊恐障碍患者在心理治疗或药物治疗后恢复不佳。结论标准化心理治疗和药物治疗对伴或不伴广泛性焦虑障碍的抑郁症患者均有效。然而，前一组的恢复时间较长，并且终身惊恐障碍患者对这些治疗缺乏反应，这表明初级保健医生应仔细评估抑郁症患者的焦虑障碍病史，以便选择适当的干预措施。
OBJECTIVE Major depression occurs with generalized anxiety disorder and panic disorder in up to 60% of psychiatric and primary care patients. This comorbidity has been associated with greater severity of depression, poorer psychosocial functioning, and poorer treatment outcomes in psychiatric samples. This study examined the clinical outcomes for depressed primary care patients with and without a lifetime anxiety disorder. METHOD A total of 157 primary care patients who met criteria for major depression were randomly assigned to standardized interpersonal psychotherapy or pharmacotherapy with nortriptyline and were assessed at baseline and at 4 and 8 months on severity of depression, psychosocial functioning, and health-related functioning. RESULTS Depressed patients with a comorbid anxiety disorder presented with significantly more psychopathology and tended to prematurely terminate treatment more frequently than patients with major depression alone. Both standardized depression-specific treatments were effective for depressed patients with and without a comorbid generalized anxiety disorder, although time to recovery was longer for the former. Patients with lifetime panic disorder showed poor recovery in response to psychotherapy or pharmacotherapy. CONCLUSIONS Standardized psychotherapy and pharmacotherapy are effective for patients with major depression with and without a generalized anxiety disorder. However, the longer time to recovery for the former group and lack of response to these treatments by patients with lifetime panic disorder suggest that primary care physicians should carefully assess history of anxiety disorder among depressed patients so as to select a proper intervention.