Adding Psychotherapy to Pharmacotherapy in the Treatment of Depressive Disorders in Adults: A Meta-Analysis
Adding Psychotherapy to Pharmacotherapy in the Treatment of Depressive Disorders in Adults: A Meta-Analysis
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DOI：
10.4088/jcp.09r05021
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发表时间：
2009-09-01
影响因子：
5.3
通讯作者：
Andersson, Gerhard
中科院分区：
文献类型：
--
作者：
Cuijpers, Pim;Dekker, Jack;Andersson, Gerhard
目的：大量研究探讨了在药物治疗中加入心理治疗是否比单独药物治疗产生更强的效果。然而，该领域早期的荟萃分析仅包括有限数量的可用研究，并且没有进行扩展的亚组分析来检查异质性的可能来源。 数据来源：我们使用的数据库源自对 Pubmed、PsycINFO、EMBASE 和 Cochrane 对照试验中心注册库的综合文献检索，这些研究针对 1966 年至 2008 年 1 月发表的研究抑郁症的心理治疗。这些研究的摘要是通过组合表示心理治疗和抑郁症的术语来确定的。研究选择：我们纳入了随机试验，其中将药物治疗的效果与药物和心理联合治疗对患有抑郁症的成人的效果进行比较。数据提取：对于每项研究，我们计算了标准化的平均效应大小，表明药物治疗与联合治疗之间的差异。我们还对人群的主要特征、干预措施以及研究的质量和设计进行了编码。数据综合：纳入了 25 项随机试验，总共 2,036 名患者。 25 项纳入研究的平均效应大小为 d=0.31（95% CI，0.20 与 0.43 相似），表明联合治疗相对于单独药物治疗的效果较小。与针对重度抑郁症患者的研究相比，针对心境恶劣患者的研究产生的效应显着较低，这一发现表明心理治疗对心境恶劣患者的附加价值较低。与单纯药物治疗组相比，联合治疗组的退出率显着较低（OR = 0.65；95% CI，0.50 与 0.83 相似）。结论：与单独药物治疗相比，心理治疗似乎对抑郁症具有额外的价值。 Clin Psychiatry 2009;70(9):1219-1229 (C) Copyright 2009 Physicians Postgraduate Press, Inc.
Objective: A considerable number of studies has examined whether adding psychotherapy to pharmacotherapy results in stronger effects than pharmacotherapy alone. However, earlier meta-analyses in this field have included only a limited number of available studies and did not conduct extended subgroup analyses to examine possible sources of heterogeneity.Data Sources: We used a database derived from a comprehensive literature search in Pubmed, PsycINFO, EMBASE, and the Cochrane Central Register of Controlled Trials for studies published from 1966 to January 2008 that examined the psychological treatment of depression. The abstracts of these studies were identified by combining terms indicative of psychological treatment and depression.Study Selection: We included randomized trials in which the effects of a pharmacologic treatment were compared to the effects of a combined pharmacologic and psychological treatment in adults with a depressive disorder.Data Extraction: For each of the studies, we calculated a standardized mean effect size indicating the difference between pharmacotherapy and the combined treatment at posttest. We also coded major characteristics of the population, the interventions, and the quality and design of the study.Data Synthesis: Twenty-five randomized trials, with a total of 2,036 patients, were included. A mean effect size of d=0.31 (95% CI, 0.20 similar to 0.43) was found for the 25 included studies, indicating a small effect in favor of the combined treatment over pharmacotherapy alone. Studies aimed at patients with dysthymia resulted in significantly lower effect sizes compared to studies aimed at patients with major depression, a finding that suggests that the added value of psychotherapy is less in patients with dysthymia. The dropout rate was significantly lower in the combined treatment group compared to the pharmacotherapy only group (OR = 0.65; 95% CI, 0.50 similar to 0.83).Conclusions: Psychotherapy seems to have an additional value compared to pharmacotherapy alone for depression. Clin Psychiatry 2009;70(9):1219-1229 (C) Copyright 2009 Physicians Postgraduate Press, Inc.