Combining psychotherapy and antidepressants in the treatment of depression
Combining psychotherapy and antidepressants in the treatment of depression
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DOI：
10.1016/s0165-0327(00)00259-7
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发表时间：
2001-05-01
影响因子：
6.6
通讯作者：
Peen, J
中科院分区：
文献类型：
--
作者：
de Jonghe, F;Kool, S;Peen, J
目的：比较抗抑郁药与抗抑郁药加心理疗法(“综合疗法”)治疗抑郁症的疗效。方法：对17项HDRS基线评分至少14分的重度抑郁症患者进行6个月的随机临床试验，包括抗抑郁药物(N=84)和联合治疗(N=83)。抗抑郁方案规定了在不耐受或无效的情况下的三个连续步骤：氟西汀、阿米替林和吗氯贝胺。除了药物治疗外，综合治疗条件还包括16个疗程的短期心理动力支持性心理治疗。疗效评定采用17项HDRS、严重程度和改善程度的CGI、SCL-90的抑郁子量表和生活质量抑郁量表。对三个样本进行了数据分析：意向治疗样本、按方案样本和观察病例样本。结果：随机分组后，32%的患者拒绝建议的药物治疗，13%的患者拒绝建议的综合治疗。在24周内，开始接受药物治疗的患者中有40%停止服药；接受联合治疗的患者中有22%这样做。治疗8、Ib和24周后，分别有23%、31%和62%的患者倾向于综合治疗，成功率的差异在统计学上是显著的。24周时，药物治疗组平均成功率为40.7%，综合治疗组平均成功率为59.2%。结论：患者发现联合治疗更容易接受，他们退出联合治疗的可能性显著降低，最终明显更有可能康复。综合疗法较药物疗法更适用于门诊抑郁症的治疗。(C)2001 Elsevier Science B.V.保留所有权利。
Objective: To compare the efficacy of antidepressants with that of antidepressants plus psychotherapy ("combined therapy") in the treatment of depression. Method: 6 month randomised clinical trial of antidepressants (N = 84) and combined therapy (N = 83) in ambulatory patients with Major Depression and a 17-item HDRS baseline score of at least 14 points. The antidepressant protocol provides for three successive steps in case of intolerance or inefficacy: fluoxetine, amitriptyline and moclobemide. The combined therapy condition consists, in addition to pharmacotherapy, of 16 sessions of Short Psychodynamic Supportive Psychotherapy. Efficacy is assessed using the 17-item HDRS, the CGI of Severity and of Improvement, the depression subscale of the SCL-90, and the Quality of Life Depression Scale. Thr data analysis is conducted on three samples: the intention-to-treat sample, the per protocol sample and the observed cases sample. Results: After randomisation, 32% of the patients refused the proposed pharmacotherapy while 13% refused the proposed combined therapy. In 24 weeks, 40% of the patients who started with the pharmacotherapy stopped medication; 22% of those receiving the combined therapy did so. The difference in success rates is statistically significant, favouring combined therapy, in 23%, 31% and 62% of the patients after 8, Ib and 24 weeks of treatment, respectively. At week 24, the mean success rate is 40.7% in the pharmacotherapy group and 59.2% in the combined therapy group. Conclusion: Patients found combined treatment significantly more acceptable, they were significantly less likely to drop out of combined therapy and, ultimately, significantly more likely to recover. Combined therapy is preferable to pharmacotherapy in the treatment of ambulatory patients with major depression. (C) 2001 Elsevier Science B.V. All rights reserved.