Winter Depression Recurrence One Year After Cognitive-Behavioral Therapy, Light Therapy, or Combination Treatment
Winter Depression Recurrence One Year After Cognitive-Behavioral Therapy, Light Therapy, or Combination Treatment
复制标题
DOI：
10.1016/j.beth.2008.06.004
复制
发表时间：
2009-09-01
期刊：
影响因子：
3.7
通讯作者：
Vacek, Pamela M.
中科院分区：
文献类型：
--
作者：
Rohan, Kelly J.;Roecklein, Kathryn A.;Vacek, Pamela M.
季节性情感障碍（SAD）管理的中心公共卫生挑战是预防每个秋季/冬季的抑郁症复发。由于临床实践指南建议在每年有症状的月份期间进行每日光疗的长期合规性值得怀疑，因此强调了对具有持久效果的限时治疗的需求。我们之前开发了一种针对SAD的群体认知行为疗法（CBT），并在2项试点研究中测试了其急性疗效。在这里，我们报告了在随后的冬季（即，急性治疗后约1年），使用我们的初步研究中随机分配到CBT，光疗法和联合治疗的参与者（N=69）。我们使用多重插补来估计17名在治疗期间脱落、退出方案或失访的个体的下一个冬季结果。CBT（7.0%）和联合治疗（5.5%）组的冬季抑郁症复发率明显低于光治疗组（36.7%）。与单独的光疗法相比，单独的CBT，而不是联合治疗，也与1年时访谈者和患者评定的抑郁严重程度显着降低相关。在提供1年数据的完成者中，CBT组和光疗法组之间的所有统计学显著差异在调整了正在进行的光疗法、抗抑郁药和心理疗法治疗后仍然存在。如果这些发现被复制，CBT可能是一种比光疗法更有效，实用和可口的长期SAD管理方法。
The central public health challenge in the management of seasonal affective disorder (SAD) is prevention of depression recurrence each fall/winter season. The need for time-limited treatments with enduring effects is underscored by questionable long-term compliance with clinical practice guidelines recommending daily light therapy during the symptomatic months each year. We previously developed a SAD-tailored group cognitive-behavioral therapy (CBT) and tested its acute efficacy in 2 pilot studies. Here, we report an intent-to-treat (ITT) analysis of outcomes during the subsequent winter season (i.e., approximately 1 year after acute treatment) using participants randomized to CBT, light therapy, and combination treatment across our pilot studies (N=69). We used multiple imputation to estimate next winter outcomes for the 17 individuals who dropped out during treatment, were withdrawn from protocol, or were lost to follow-up. The CBT (7.0%) and combination treatment (5.5%) groups had significantly smaller proportions of winter depression recurrences than the light therapy group (36.7%). CBT alone, but not combination treatment, was also associated with significantly lower interviewer- and patient-rated depression severity at 1 year as compared to light therapy alone. Among completers who provided 1-year data, all statistically significant differences between the CBT and light therapy groups persisted after adjustment for ongoing treatment with light therapy, antidepressants, and psychotherapy. If these findings are replicated, CBT could represent a more effective, practical, and palatable approach to long-term SAD management than light therapy.