Prevention of recurrent depression with cognitive behavioral therapy - Preliminary findings
Prevention of recurrent depression with cognitive behavioral therapy - Preliminary findings
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DOI：
10.1001/archpsyc.55.9.816
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发表时间：
1998-09-01
影响因子：
--
通讯作者：
Belluardo, P
中科院分区：
文献类型：
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作者：
Fava, GA;Rafanelli, C;Belluardo, P
背景：在成功的药物治疗后，认知行为治疗（CBT）对原发性重度抑郁症患者的残余症状的复发率明显低于临床治疗。本研究的目的是测试这种方法在复发性抑郁症患者（大于或等于3次抑郁症发作）中的有效性。方法：将40例经抗抑郁药物治疗成功的复发性重度抑郁症患者随机分配到CBT治疗残余症状组（辅以生活方式改变和幸福感治疗）或临床治疗组。在为期20周的实验中，两组的抗抑郁药物服用都逐渐减少并停止。残余症状用改良版的Paykel抑郁症临床访谈法进行测量。进行了两年的随访，在此期间没有使用抗抑郁药物，除非随后复发。结果：CBT组停药后残留症状明显低于临床管理组。在2年的随访中，CBT也是。结果复发率（25%）低于临床治疗（80%）。经生存分析，差异有统计学意义。结论：这些结果挑战了长期药物治疗是预防复发性抑郁症患者复发的唯一工具的假设。虽然维持药物治疗似乎是必要的一些患者，CBT为其他患者提供了一个可行的选择。残留症状的改善可以通过影响残留症状向复发前驱症状的进展来降低抑郁症患者复发的风险。
Background: Cognitive behavioral treatment (CBT) of residual symptoms after successful pharmacotherapy yielded a substantially lower relapse rate than did clinical management in patients with primary major depressive disorders. The aim of this study was to test the effectiveness of this approach in patients with recurrent depression (greater than or equal to 3 episodes of depression).Methods: Forty patients with recurrent major depression who had been successfully treated with antidepressant drugs were randomly assigned to either CBT of residual symptoms (supplemented by lifestyle modification and well-being therapy) or clinical management. In both groups, during the 20-week experiment, antidepressant drug administration was tapered and discontinued. Residual symptoms were measured with a modified version of the Paykel Clinical Interview for Depression. Two-year follow-up was undertaken, during which no antidepressant drugs were used unless a relapse ensued.Results: The CBT group had a significantly lower level of residual symptoms after discontinuation of drug therapy compared with the clinical management group. At 2-year follow-up, CBT also. resulted in a lower relapse rate (25%) than did clinical management (80%). This difference attained statistical significance by survival analysis.Conclusions: These results challenge the assumption that long-term drug treatment is the only tool to prevent relapse in patients with recurrent depression. Although maintenance pharmacotherapy seems to be necessary in some patients, CBT offers a viable alternative for other patients. Amelioration of residual symptoms may reduce the risk of relapse in depressed patients by affecting the progression of residual symptoms to prodromes of relapse.