Treatment of bereavement-related major depressive episodes in later life: a controlled study of acute and continuation treatment with nortriptyline and interpersonal psychotherapy.
Treatment of bereavement-related major depressive episodes in later life: a controlled study of acute and continuation treatment with nortriptyline and interpersonal psychotherapy.
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晚年与丧亲相关的重度抑郁发作的治疗：去甲替林急性治疗和持续治疗以及人际心理治疗的对照研究。
DOI：
10.1176/ajp.156.2.202
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发表时间：
1999
期刊：
影响因子：
--
通讯作者：
Kupfer,DJ
中科院分区：
文献类型：
--
作者：
Reynolds3rd,CF;Miller,MD;Pasternak,RE;Frank,E;Perel,JM;Cornes,C;Houck,PR;Mazumdar,S;Dew,MA;Kupfer,DJ
作者检验了去甲替林和人际心理治疗单独或联合治疗在缓解丧亲相关的重性抑郁发作方面上级安慰剂的假设。在失去配偶或重要他人之前6个月或之后12个月内开始重度抑郁发作的患者被随机分配到一个为期16周的双四种治疗条件之一的盲法试验：去甲替林加人际心理治疗（N=16）、药物诊所中单独使用去甲替林（N=25）、安慰剂加人际心理治疗（N=17）或药物诊所中单独使用安慰剂（N=22）。方案要求，如果汉密尔顿抑郁量表评分未改善50%，则在8周后结束急性期双盲治疗。缓解被定义为一个17项汉密尔顿量表评分为7或更低的连续3 wk.ResultsThe缓解率为去甲替林加人际心理治疗为69%（N=11）;药物诊所，去甲替林，56%（N=14）;安慰剂加人际心理治疗，29%（N=5）;和药物诊所，安慰剂，45%（N=10）。在广义logit模型中，去甲替林对安慰剂有显著影响，但没有人际心理治疗效应，也没有去甲替林与人际心理治疗的相互作用。所有原因的磨损率最低的nortriptyline加人际psychotherapygroup.ConclusionsNortriptyline是上级安慰剂在实现缓解丧亲相关的抑郁发作。药物治疗和心理治疗的结合与最高的治疗完成率相关。这些结果支持在严重的生活压力源（如丧亲之痛）之后使用药物治疗重性抑郁发作。
ObjectiveThe authors tested the hypothesis that nortriptyline and interpersonal psychotherapy, alone and in combination, are superior to placebo in achieving remission of bereavement-related major depressive episodes.MethodEighty subjects, aged 50 years and older, with major depressive episodes that began within 6 months before or 12 months after the loss of a spouse or significant other were randomly assigned to a 16-week double-blind trial of one of four treatment conditions: nortriptyline plus interpersonal psychotherapy (N=16), nortriptyline alone in a medication clinic (N=25), placebo plus interpersonal psychotherapy (N=17), or placebo alone in a medication clinic (N=22). The protocol required that the acute-phase double-blind treatment be ended after 8 weeks if Hamilton depression scale ratings had not improved by 50%. Remission was defined as a 17-item Hamilton scale score of 7 or lower for 3 consecutive weeks.ResultsThe rate of remission for nortriptyline plus interpersonal psychotherapy was 69% (N=11); for medication clinic, nortriptyline, 56% (N=14); for placebo plus interpersonal psychotherapy, 29% (N=5); and for medication clinic, placebo, 45% (N=10). In a generalized logit model, there was a significant effect of nortriptyline over placebo but no interpersonal psychotherapy effect and no nortriptyline-by-interpersonal psychotherapy interaction. Rates of all-cause attrition were lowest in the nortriptyline plus interpersonal psychotherapy group.ConclusionsNortriptyline was superior to placebo in achieving remission of bereavement-related major depressive episodes. The combination of medication and psychotherapy was associated with the highest rate of treatment completion. These results support the use of pharmacologic treatment of major depressive episodes in the wake of a serious life stressor such as bereavement.