A comparison of cognitive-behavioral therapy, sertraline, and their combination for adolescent depression
A comparison of cognitive-behavioral therapy, sertraline, and their combination for adolescent depression
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DOI：
10.1097/01.chi.0000233157.21925.71
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发表时间：
2006-10-01
影响因子：
13.3
通讯作者：
Klimkeit, Ester
中科院分区：
文献类型：
--
作者：
Melvin, Glenn A.;Tonge, Bruce J.;Klimkeit, Ester
目的：评价认知行为疗法、单独抗抑郁药物治疗及CBT联合抗抑郁药物治疗青少年抑郁症的效果。方法：73名青少年（年龄12-18岁），最初诊断为DSM-IV重度抑郁症、心境恶劣障碍或抑郁症，没有其他说明。随机分配到三种治疗方法之一。在急性治疗前后和6个月随访时进行治疗结果测量。抑郁症。诊断是主要结局指标；次要测量是自我和其他报告以及临床医生对整体功能的评价。该试验于2000年7月至2002年12月在三个社区诊所进行。数据分析采用了意向治疗策略。结果：急性治疗后，所有治疗组在预后指标（抑郁诊断、雷诺兹青少年抑郁量表、修订儿童明显焦虑量表、自杀意念问卷）上均有统计学显著改善，并在随访中保持改善。认知行为联合治疗和抗抑郁药物治疗并不优于单独治疗。与单独服用抗抑郁药物相比，单独接受认知行为治疗的参与者表现出更好的急性治疗反应（优势比= 6.86；95%可信区间为1.12-41.82）。尽管认知行为疗法被发现在治疗青少年轻度至中度抑郁症的急性治疗中优于单独使用抗抑郁药物，但这可能是因为使用的舍曲林剂量相对较低。结论：所有治疗均可减少抑郁症，但联合治疗的优势并不明显。
Objective: To evaluate cognitive-behavioral therapy, antidepressant medication alone, and combined CBT and antidepressant medication in the treatment of depressive disorders in adolescents.Method: Seventy-three adolescents (ages 12-18 years) with a primary diagnosis of DSM-IV major depressive disorder, dysthymic disorder, or depressive disorder not otherwise specified were randomly allocated to one of three treatments. Treatment outcome measures were administered before and after acute treatment, and at a 6-month follow-up. Depression. diagnosis was the primary outcome measure; secondary measures were self- and other report and clinician rating of global functioning. The trial was conducted at three community-based clinics between July 2000 and December 2002. Data analyses used an intent-to-treat strategy.Results: Following acute treatment, all treatment groups demonstrated statistically significant improvement on outcome measures (depressive diagnosis, Reynolds Adolescent Depression Scale, Revised Children's Manifest Anxiety Scale, Suicidal Ideation Questionnaire), and improvement was maintained at follow-up. Combined cognitive-behavioral therapy and antidepressant medication was not found to be superior to either treatment alone. Compared with antidepressant medication alone, participants receiving cognitive-behavioral therapy alone demonstrated a superior acute treatment response (odds ratio = 6.86; 95% confidence interval 1.12-41.82). Although cognitive-behavioral therapy was found to be superior to antidepressant medication alone for the acute treatment of mild to moderate depression among youth, this may have stemmed from the relatively low dose of sertraline, used.Conclusions: All treatments led to a reduction in depression, but the advantages of a combined approach were not evident.