Nonpharmacologic Versus Pharmacologic Treatment of Adult Patients With Major Depressive Disorder: A Clinical Practice Guideline From the American College of Physicians
Nonpharmacologic Versus Pharmacologic Treatment of Adult Patients With Major Depressive Disorder: A Clinical Practice Guideline From the American College of Physicians
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DOI：
10.7326/m15-2570
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发表时间：
2016-03-01
影响因子：
39.2
通讯作者：
Kansagara, Devan
中科院分区：
文献类型：
--
作者：
Qaseem, Amir;Barry, Michael J.;Kansagara, Devan
产品描述：美国内科医师学会（ACP）制定了本指南，以提供证据并提供临床建议，比较第二代抗抑郁药与非药物治疗成人重度抑郁症的疗效。方法：本指南基于对已发表的、英语、随机、1990年至2015年9月的对照试验使用几个数据库和通过手动搜索相关研究的参考文献进行识别。评估的干预措施包括心理治疗、补充和替代药物（包括针灸、ω-3脂肪酸、S-腺苷-L-蛋氨酸、圣约翰草[贯叶连翘]）、运动和第二代抗抑郁药。评价的结果包括反应、缓解、功能能力、生活质量、自杀或住院的减少以及危害。本指南的目标受众包括所有临床医生，目标患者人群包括重度抑郁症成人。本指南使用ACP临床实践指南分级系统对证据和建议进行分级。建议：ACP建议临床医生在与患者讨论治疗效果、不良反应、成本、可及性和偏好后，选择认知行为疗法或第二代抗抑郁药治疗重度抑郁症患者（等级：强烈建议，中等质量证据）。
Description: The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on the comparative effectiveness of treatment with second-generation antidepressants versus nonpharmacologic treatments for major depressive disorder in adults.Methods: This guideline is based on a systematic review of published, English-language, randomized, controlled trials from 1990 through September 2015 identified using several data-bases and through hand searches of references of relevant studies. Interventions evaluated include psychotherapies, complementary and alternative medicines (including acupuncture, omega-3 fatty acids, S-adenosyl-L-methionine, St. John's wort [Hypericum perforatum]), exercise, and second-generation antidepressants. Evaluated outcomes included response, remission, functional capacity, quality of life, reduction of suicidality or hospitalizations, and harms. The target audience for this guideline includes all clinicians, and the target patient population includes adults with major depressive disorder. This guideline grades the evidence and recommendations using ACP's clinical practice guidelines grading system.Recommendation: ACP recommends that clinicians select between either cognitive behavioral therapy or second-generation antidepressants to treat patients with major depressive disorder after discussing treatment effects, adverse effect profiles, cost, accessibility, and preferences with the patient (Grade: strong recommendation, moderate-quality evidence).