Prevention of relapse in residual depression by cognitive therapy -: A controlled trial
Prevention of relapse in residual depression by cognitive therapy -: A controlled trial
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DOI：
10.1001/archpsyc.56.9.829
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发表时间：
1999-09-01
影响因子：
--
通讯作者：
Pope, M
中科院分区：
文献类型：
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作者：
Paykel, ES;Scott, J;Pope, M
背景资料：以往的研究表明，部分缓解和残留症状的抑郁症患者抗抑郁药治疗后是常见的，复发率高。有证据表明，认知疗法可以降低抑郁症的复发率。研究方法：158例近期重度抑郁症患者，经抗抑郁治疗（平均日剂量相当于185 mg阿米替林或33 mg氟西汀）部分缓解，但残留症状持续2至18个月，被纳入对照试验。受试者随机接受单独的临床管理或临床管理加认知治疗，在20周内进行16次治疗，随后进行2次加强治疗。在整个20周的治疗期间和接下来的一年里，定期对受试者进行评估。他们在整个过程中接受相同剂量的持续和维持抗抑郁药。结果如下：在意向治疗和按方案治疗样本中，认知治疗降低了急性重性抑郁症和持续严重残留症状的复发率。68周时的累积复发率显著降低，从临床管理对照组的47%降至认知治疗组的29%（风险比0.54; 95%置信区间，0.32-0.93;意向治疗分析）。认知治疗还提高了20周时的完全缓解率，但并未显着改善症状评级。结论：在这个难治的残余抑郁症患者组中，尽管抗抑郁药治疗，但仅显示部分反应，认知疗法产生了值得的益处。
Background: Previous studies indicate that depressed patients with partial remission and residual symptoms following antidepressant treatment are common and have high rates of relapse. There is evidence that cognitive therapy may reduce relapse rates in depression. Methods: One hundred fifty-eight patients with recent major depression, partially remitted with antidepressant treatment (mean daily doses equivalent to 185 mg of amitriptyline or 33 mg of fluoxetine) but with residual symptoms of 2 to 18 months' duration, were included in a controlled trial. Subjects were randomized to receive clinical management alone or clinical management plus cognitive therapy for 16 sessions during 20 weeks, with 2 subsequent booster sessions. Subjects were assessed regularly throughout the 20 weeks' treatment and for a further year. They received continuation and maintenance antidepressants at the same dose throughout. Results: Cognitive therapy reduced relapse rates for acute major depression and persistent severe residual symptoms, in both intention to treat and treated per protocol samples. The cumulative relapse rate at 68 weeks was reduced significantly, from 47% in the clinical management control group to 29% with cognitive therapy (hazard ratio 0.54; 95% confidence interval, 0.32-0.93; intention to treat analysis). Cognitive therapy also increased full remission rates at 20 weeks but did not significantly improve symptom ratings. Conclusion: In this difficult-to-treat group of patients with residual depression who showed only partial response despite antidepressant treatment, cognitive therapy produced worthwhile benefit.