A network meta-analysis of the effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression
A network meta-analysis of the effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression
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DOI：
10.1002/wps.20701
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发表时间：
2020-02-01
期刊：
影响因子：
73.3
通讯作者：
Furukawa, Toshi A.
中科院分区：
文献类型：
--
作者：
Cuijpers, Pim;Noma, Hisashi;Furukawa, Toshi A.
心理治疗、药物治疗及其联合治疗在成人抑郁症治疗中的相对效果还没有网络meta分析，而这是一个非常重要的临床问题。我们在文献数据库中进行了系统的搜索，以确定随机试验，其中心理治疗和药物治疗对抑郁症的急性或长期治疗进行了相互比较，或者将心理治疗和药物治疗相结合与单独进行比较。主要结局是治疗反应（基线和终点之间改善50%）。缓解和可接受性（定义为因任何原因退出研究）也被检查。评估的可能调节因素包括慢性和治疗难治性抑郁症以及抑郁症的基线严重程度。使用随机效应模型汇总数据作为相对风险（RR）。共纳入101项研究，11910例患者。大多数研究中的抑郁症是中度到重度的。在网络荟萃分析中，在治疗结束时，联合治疗比单独进行心理治疗（RR=1.27; 95% CI: 1.14-1.39）和单独进行药物治疗（RR=1.25; 95% CI: 1.14-1.37）更有效。单纯心理治疗与单纯药物治疗无显著差异（RR=0.99; 95% CI: 0.92-1.08）。缓解期也有类似的结果。联合治疗（RR=1.23; 95% CI: 1.05-1.45）和单独心理治疗（RR=1.17; 95% CI: 1.02-1.32）比药物治疗更可接受。慢性和难治性抑郁症的结果相似。心理治疗与药物治疗相结合似乎是治疗中度抑郁症的最佳选择。需要对治疗的长期效果（包括成本效益）、特定药理学和非药理学方法的影响以及特定患者群体的效果进行更多的研究。
No network meta-analysis has examined the relative effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression, while this is a very important clinical issue. We conducted systematic searches in bibliographical databases to identify randomized trials in which a psychotherapy and a pharmacotherapy for the acute or long-term treatment of depression were compared with each other, or in which the combination of a psychotherapy and a pharmacotherapy was compared with either one alone. The main outcome was treatment response (50% improvement between baseline and endpoint). Remission and acceptability (defined as study drop-out for any reason) were also examined. Possible moderators that were assessed included chronic and treatment-resistant depression and baseline severity of depression. Data were pooled as relative risk (RR) using a random-effects model. A total of 101 studies with 11,910 patients were included. Depression in most studies was moderate to severe. In the network meta-analysis, combined treatment was more effective than psychotherapy alone (RR=1.27; 95% CI: 1.14-1.39) and pharmacotherapy alone (RR=1.25; 95% CI: 1.14-1.37) in achieving response at the end of treatment. No significant difference was found between psychotherapy alone and pharmacotherapy alone (RR=0.99; 95% CI: 0.92-1.08). Similar results were found for remission. Combined treatment (RR=1.23; 95% CI: 1.05-1.45) and psychotherapy alone (RR=1.17; 95% CI: 1.02-1.32) were more acceptable than pharmacotherapy. Results were similar for chronic and treatment-resistant depression. The combination of psychotherapy and pharmacotherapy seems to be the best choice for patients with moderate depression. More research is needed on long-term effects of treatments (including cost-effectiveness), on the impact of specific pharmacological and non-pharmacological approaches, and on the effects in specific populations of patients.