Non-pharmacological treatment of depression: a systematic review and evidence map.
Non-pharmacological treatment of depression: a systematic review and evidence map.
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DOI：
10.1136/ebmed-2016-110522
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发表时间：
2016-12-01
期刊：
影响因子：
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通讯作者：
LeBlanc, Annie
中科院分区：
文献类型：
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作者：
Farah, Wigdan H;Alsawas, Mouaz;LeBlanc, Annie
背景：非药物治疗抑郁症的相对有效性尚不清楚。方法：我们进行了一项系统综述，以确定随机对照试验（rct），比较非药物治疗抑郁症的疗效和不良反应。我们检索了截至2016年2月的多个电子数据库，没有语言限制。对审稿人确定资格，提取数据并评估偏倚风险。适当时进行meta分析。结果：我们纳入了367项随机对照试验，纳入了2万名患者，接受了11种治疗方法，进行了17项独特的头对头比较。认知行为疗法、自然疗法、生物干预和体育活动干预降低了抑郁症的严重程度。然而，这些非药物干预措施的相对疗效是缺乏的。这些干预措施对临床反应和缓解的影响尚不清楚。不良事件低于抗抑郁药。局限性：由于不一致和不明确或高偏倚风险，证据质量为低至中等，限制了我们对研究结果的信心。结论：抑郁症的非药物治疗可减轻抑郁症状，在治疗轻至重度抑郁症时应考虑联合抗抑郁药物治疗。在基于价值观、偏好、临床和社会背景的非药物治疗之间进行选择时，需要一个共同的决策方法。
BACKGROUND: The comparative effectiveness of non-pharmacological treatments of depression remains unclear.METHODS: We conducted an overview of systematic reviews to identify randomised controlled trials (RCTs) that compared the efficacy and adverse effects of non-pharmacological treatments of depression. We searched multiple electronic databases through February 2016 without language restrictions. Pairs of reviewers determined eligibility, extracted data and assessed risk of bias. Meta-analyses were conducted when appropriate.RESULT: We included 367 RCTs enrolling 20 000 patients treated with 11 treatments leading to 17 unique head-to-head comparisons. Cognitive behavioural therapy, naturopathic therapy, biological interventions and physical activity interventions reduced depression severity as measured using standardised scales. However, the relative efficacy among these non-pharmacological interventions was lacking. The effect of these interventions on clinical response and remission was unclear. Adverse events were lower than antidepressants.LIMITATION: The quality of evidence was low to moderate due to inconsistency and unclear or high risk of bias, limiting our confidence in findings.CONCLUSIONS: Non-pharmacological therapies of depression reduce depression symptoms and should be considered along with antidepressant therapy for the treatment of mild-to-severe depression. A shared decision-making approach is needed to choose between non-pharmacological therapies based on values, preferences, clinical and social context.