Cognitive therapy vs medications in the treatment of moderate to severe depression
Cognitive therapy vs medications in the treatment of moderate to severe depression
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DOI：
10.1001/archpsyc.62.4.409
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发表时间：
2005-04-01
影响因子：
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通讯作者：
Gallop, R
中科院分区：
文献类型：
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作者：
DeRubeis, RJ;Hollon, SD;Gallop, R
目的：在一项安慰剂对照试验中，比较抗抑郁药物和认知疗法对中重度抑郁症的疗效。设计：随机分配到以下组：16周的药物治疗(n=120)、16周的认知治疗(n=60)或8周的安慰剂(n=60)。地点：宾夕法尼亚大学，费城，以及田纳西州纳什维尔的范德比尔特大学的研究诊所。患者：240名门诊患者，年龄18-70岁干预：一些研究对象服用帕罗西汀，每天最多50毫克，必要时加用碳酸锂或盐酸地塞帕明；结果：8周时，药物组(50%)和认知治疗组(43%)的有效率均优于安慰剂组(25%)。基于8周连续评分的分析表明，每种有效治疗都比安慰剂有优势，每种治疗的效果都是中等的。相对于安慰剂，药物治疗的优势是显著的，而且相对于安慰剂，认知治疗的趋势并不显著。在16周时，每种活跃状态的有效率为58%；药物组缓解率为46%，认知疗法组缓解率为40%。对Site X治疗交互作用的后续测试表明，只有在范德比尔特大学有显著差异，那里的药物治疗优于认知治疗。患者特征和认知治疗师相对经验水平的地点差异似乎都是导致这种互动的原因。结论：认知治疗对于中到重度抑郁症的初始治疗可以与药物治疗一样有效，但这种有效程度可能取决于治疗师的高水平经验或专业知识。
Background: There is substantial evidence that antidepressant medications treat moderate to severe depression effectively, but there is less data on cognitive therapy's effects in this population.Objective: To compare the efficacy in moderate to severe depression of antidepressant medications with cognitive therapy in a placebo-controlled trial.Design: Random assignment to one of the following: 16 weeks of medications (n = 120), 16 weeks of cognitive therapy (n = 60), or 8 weeks of pill placebo (n = 60).Setting: Research clinics at the University of Pennsylvania, Philadelphia, and Vanderbilt University, Nashville, Tenn.Patients: Two hundred forty outpatients, aged 18 to 70 years, with moderate to severe major depressive disorder.Interventions: Some study subjects received paroxetine, up to 50 mg daily, augmented by lithium carbonate or desipramine hydrochloride if necessary; others received individual cognitive therapy.Main Outcome Measure: The Hamilton Depression Rating Scale provided continuous severity scores and allowed for designations of response and remission.Results: At 8 weeks, response rates in medications (50%) and cognitive therapy (43%) groups were both superior to the placebo (25%) group. Analyses based on continuous scores at 8 weeks indicated an advantage for each of the active treatments over placebo, each with a medium effect size. The advantage was significant for medication relative to placebo, and at the level of a nonsignificant trend for cognitive therapy relative to placebo. At 16 weeks, response rates were 58% in each of the active conditions; remission rates were 46% for medication, 40% for cognitive therapy. Follow-up tests of a site X treatment interaction indicated a significant difference only at Vanderbilt University, where medications were superior to cognitive therapy. Site differences in patient characteristics and in the relative experience levels of the cognitive therapists each appear to have contributed to this interaction.Conclusion: Cognitive therapy can be as effective as medications for the initial treatment of moderate to severe major depression, but this degree of effectiveness may depend on a high level of therapist experience or expertise.