Medications versus cognitive behavior therapy for severely depressed outpatients: mega-analysis of four randomized comparisons.
Medications versus cognitive behavior therapy for severely depressed outpatients: mega-analysis of four randomized comparisons.
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DOI：
10.1176/ajp.156.7.1007
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发表时间：
1999-07
期刊：
影响因子：
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通讯作者：
R. DeRubeis;L. Gelfand;Tony Z. Tang;A. Simons
中科院分区：
文献类型：
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作者：
R. DeRubeis;L. Gelfand;Tony Z. Tang;A. Simons
目的本研究的目的是比较抗抑郁药物和认知行为治疗在四个主要随机试验的严重抑郁症门诊亚组中的急性结局。次要目的是比较国家精神卫生研究所抑郁症治疗合作研究计划（治疗指南的基础）与其他三项研究的结果。方法分别比较了四项研究中抗抑郁药物和认知行为治疗的结果，并对四项研究中的患者进行了汇总。此外，将抑郁症治疗合作研究项目的抗抑郁药物和认知行为治疗条件的结果与其他三项研究的结果进行比较。结果：抗抑郁药物与认知行为治疗的总体效应量比较有利于认知行为治疗，但比较两种治疗方式的试验并未显示出任何一种治疗方式的显著优势。结论：在四项主要的比较中，认知行为疗法在严重抑郁症门诊患者中的表现与抗抑郁药物一样好。在当前或未来的比较试验结果出现之前，根据经验证据，抗抑郁药物不应被认为在严重抑郁症门诊患者的急性治疗中上级认知行为疗法。
OBJECTIVE The purpose of this study was to compare the acute outcomes of antidepressant medication and cognitive behavior therapy in the severely depressed outpatient subgroups of four major randomized trials. A secondary objective was to compare the results obtained in the National Institute of Mental Health Treatment of Depression Collaborative Research Program, upon which treatment guidelines have been based, with those obtained in the other three studies. METHOD Outcomes of antidepressant medication and cognitive behavior therapy were compared within each of the four studies separately and for patients aggregated across the four studies. In addition, the outcomes in the antidepressant medication and cognitive behavior therapy conditions of the Treatment of Depression Collaborative Research Program were compared with those obtained in the other three studies. RESULTS The overall effect sizes comparing antidepressant medication to cognitive behavior therapy favored cognitive behavior therapy, but tests comparing the two modalities did not reveal a significant advantage for either modality overall. CONCLUSIONS Cognitive behavior therapy has fared as well as antidepressant medication with severely depressed outpatients in four major comparisons. Until findings emerge from current or future comparative trials, antidepressant medication should not be considered, on the basis of empirical evidence, to be superior to cognitive behavior therapy for the acute treatment of severely depressed outpatients.