Melancholic and atypical depression as predictor and moderator of outcome in cognitive behavior therapy and pharmacotherapy for adult depression
Melancholic and atypical depression as predictor and moderator of outcome in cognitive behavior therapy and pharmacotherapy for adult depression
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DOI：
10.1002/da.22580
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发表时间：
2017-03-01
影响因子：
7.4
通讯作者：
Hollon, Steven D.
中科院分区：
文献类型：
--
作者：
Cuijpers, Pim;Weitz, Erica;Hollon, Steven D.
背景忧郁症和非典型抑郁症被广泛认为可以调节或预测成人抑郁症的药物和心理治疗的结果，但这一点尚未得到证实。这项研究使用了四项早期比较认知行为疗法(CBT)和抗抑郁药物(ADMS；如果有的话，还有安慰剂)的数据，在单个患者的数据荟萃分析中检查忧郁症和非典型抑郁症缓和或预测结果的程度。方法我们进行了系统的搜索，直接比较CBT和ADM，联系研究人员，将这些研究的结果数据集整合到一个大型数据集，并根据DSM-IV标准选择基线(n=4,805名患者)包括忧郁症或非典型抑郁亚型的研究。结果在所有的分析中，没有发现忧郁或非典型抑郁能够显著降低结果(表明这些患者在CBT中的结果比ADM更好或更差；即，交互作用)，独立于治疗组预测结果(即，主效应)，或者在给定的模式下预测结果。有忧郁症或不典型抑郁的患者与无抑郁的患者之间的结果差异一直很小(所有效应大小均为0.10)。结论我们没有发现任何迹象表明忧郁或不典型抑郁是CBT和ADM结果的显著或相关的调节或预测因素。
BackgroundMelancholic and atypical depression are widely thought to moderate or predict outcome of pharmacological and psychological treatments of adult depression, but that has not yet been established. This study uses the data from four earlier trials comparing cognitive behavior therapy (CBT) versus antidepressant medications (ADMs; and pill placebo when available) to examine the extent to which melancholic and atypical depression moderate or predict outcome in an individual patient data meta-analysis.MethodsWe conducted a systematic search for studies directly comparing CBT versus ADM, contacted the researchers, integrated the resulting datasets from these studies into one big dataset, and selected the studies that included melancholic or atypical depressive subtyping according to DSM-IV criteria at baseline (n = 4, with 805 patients). After multiple imputation of missing data at posttest, mixed models were used to conduct the main analyses.ResultsIn none of the analyses was melancholic or atypical depression found to significantly moderate outcome (indicating a better or worse outcome of these patients in CBT compared to ADM; i.e., an interaction), predict outcome independent of treatment group (i.e., a main effect), or predict outcome within a given modality. The outcome differences between patients with melancholia or atypical depression versus those without were consistently very small (all effect sizes g < 0.10).ConclusionsWe found no indication that melancholic or atypical depressions are significant or relevant moderators or predictors of outcome of CBT and ADM.