Antidepressant drugs and generic counselling for treatment of major depression in primary care: randomised trial with patient preference arms
Antidepressant drugs and generic counselling for treatment of major depression in primary care: randomised trial with patient preference arms
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DOI：
10.1136/bmj.322.7289.772
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发表时间：
2001-03-31
影响因子：
105.7
通讯作者：
Harrison, G
中科院分区：
文献类型：
--
作者：
Chilvers, C;Dewey, M;Harrison, G
目的比较抗抑郁药物与普通心理咨询治疗轻中度抑郁症的临床疗效。为了确定随机分配治疗的患者和表现出治疗偏好的患者的结果是否相似。设计随机对照试验，患者偏好手臂。在8周和12个月进行随访，提取GP病例记录。在Trent地区设置31个全科实践。18-70岁符合重度抑郁症研究诊断标准的参与者；103名患者被随机抽样，220名患者被招募到优先组。主要结果衡量平均Beck抑郁问卷评分、缓解时间、精神病学家使用所有数据来源评估的总体结果以及研究诊断标准。结果12个月时，随机组的平均Beck评分之间没有差异。结合随机分组和患者偏好分组，Beck评分的差异为0.4(95%可信区间-2.7至3.5)。患者选择：咨询比随机咨询做得更好(贝克评分的平均差异为4.6，0.0至9.2)。精神病学家对结果的总体评估在任何一组之间都没有区别。结果已知的受试者中，221/265(83%)患者病情缓解。随机服用抗抑郁药组的中位缓解时间比其他三组短(2个月比3个月)。33/221(15%)患者复发。结论对于轻、中度抑郁症患者，基因咨询与抗抑郁药物治疗效果相当，但抗抑郁药物治疗的患者恢复较快。全科医生应该允许患者接受他们喜欢的治疗。
Objectives To compare the efficacy of antidepressant drugs and generic counselling for treating mild to moderate depression in general practice. To determine whether the outcomes were similar for patients with randomly allocated treatment and those expressing a treatment preference.Design Randomised controlled trial, with patient preference arms. Follow up at 8 weeks and 12 months and abstraction of GP case notes.Setting 31 general practices in Trent region.Participants Patients aged 18-70 who met research diagnostic criteria for major depression; 103 patients were randomised and 220 patients were recruited to the preference arms.Main outcome measures Difference in mean Beck depression inventory score; time to remission; global outcome assessed by a psychiatrist using all data sources; and research diagnostic criteria.Results At 12 months there was no difference between the mean Beck scores in the randomised arms. Combining the randomised and patient preference groups, the difference in Beck scores was 0.4 (95% confidence interval -2.7 to 3.5). Patients choosing: counselling did better than those randomised to it (mean difference in Beck score 4.6, 0.0 to 9.2). There was no difference in the psychiatrist's overall assessment of outcome between any of the groups. 221/265(83%) of participants with a known outcome had a remission. Median time to remission was shorter in the group randomised to antidepressants than the other three groups (2 months v 3 months). 33/221 (15%) patients had a relapse.Conclusions Genetic counselling seems to be as effective as antidepressant treatment for mild to moderate depressive illness, although patients receiving antidepressants may recover more quickly. General practitioners should allow patients to have their preferred treatment.