A Randomized Controlled Trial of Mindfulness-Based Cognitive Therapy for Treatment-Resistant Depression.
A Randomized Controlled Trial of Mindfulness-Based Cognitive Therapy for Treatment-Resistant Depression.
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DOI：
10.1159/000442260
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发表时间：
2016
影响因子：
22.8
通讯作者：
Feldman MD
中科院分区：
文献类型：
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作者：
Eisendrath SJ;Gillung E;Delucchi KL;Segal ZV;Nelson JC;McInnes LA;Mathalon DH;Feldman MD
由于难治性抑郁症（TRD）的临床挑战，我们评估了基于正念的认知疗法（MBCT）相对于结构等效的活性比较条件的疗效，作为TRD中常规治疗（TAU）药物治疗的替代品。这项单中心随机对照试验比较了为期8周的MBCT和健康增强计划（HEP），包括体能，音乐治疗和营养教育，作为对TRD门诊成人TAU药物治疗的补充。主要结果是抑郁严重程度的变化，通过17项汉密尔顿抑郁评定量表（HAM-D17）总分的减少百分比来衡量，次要抑郁指标是治疗反应和缓解。我们招募了173名成年人，平均抑郁发作时间为6.8年（标准差= 8.9）。在8周治疗结束时，多变量分析显示，相对于HEP条件，MBCT条件与HAM-D17的平均百分比降低显著更大（36.6%对25.3%; p= 0.01）和治疗应答率显著更高（30.3%对15.3%; p= 0.03）相关。虽然MBCT在数值上上级HEP，但两种治疗的缓解率无显著差异（22.4% vs 13.9%; p= 0.15）。在这些模型中，状态焦虑、感知压力和人格障碍的存在对结果有不利影响。MBCT显著降低了抑郁症的严重程度，提高了8周的治疗反应率，但没有缓解率。MBCT似乎是一个可行的辅助治疗TRD。
Due to the clinical challenges of treatment-resistant depression (TRD), we evaluated the efficacy of Mindfulness-Based Cognitive Therapy (MBCT) relative to a structurally equivalent active comparison condition as adjuncts to treatment-as-usual (TAU) pharmacotherapy in TRD. This single site, randomized controlled trial compared 8-week courses of MBCT and the Health-Enhancement Program (HEP), comprising physical fitness, music therapy and nutritional education, as adjuncts to TAU pharmacotherapy for outpatient adults with TRD. The primary outcome was change in depression severity, measured by percent reduction in total score on the 17-item Hamilton Depression Rating Scale (HAM-D17), with secondary depression indicators of treatment response and remission. We enrolled 173 adults, mean length of current depressive episode was 6.8 years (sd = 8.9). At the end of 8-week treatment, a multivariate analysis showed that relative to the HEP condition, the MBCT condition was associated with a significantly greater mean percent reduction on the HAM-D17 (36.6% versus 25.3%; p=.01) and a significantly higher rate of treatment responders (30.3% versus 15.3%; p=.03). Although numerically superior for MBCT than for HEP, the rates of remission did not significantly differ between treatments (22.4% versus 13.9%; p=.15). In these models, state anxiety, perceived stress, and the presence of personality disorder had adverse effects on outcomes. MBCT significantly decreased depression severity and improved treatment response rates at 8 weeks, but not remission rates. MBCT appears to be a viable adjunct in the management of TRD.