Combined Cognitive-Behavioral and Pharmacological Continuation and Maintenance Treatment of Recurrent Depression

虽然复发性抑郁症是药物维持治疗的既定指标，但缺乏对持续或维持治疗中额外认知行为治疗的长期益处的经验支持。本研究的主要目的是在一项多中心、对照、随机试验中，比较认知行为维持治疗（CBMT）加药物持续/维持治疗（常规治疗，TAU）与手动心理教育（MAPE）加TAU治疗复发性抑郁症门诊患者的长期结局。纳入符合以下标准的患者：诊断为复发性抑郁障碍（≥ 3次重度抑郁发作，MDE），目前处于缓解期; MDE急性治疗后8周内完全缓解;干预前12个月内至少有1次指数抑郁发作。排除标准为：器质性疾病;精神药物引起的心理/行为障碍;精神分裂症;情感性精神障碍;双相抑郁症;中度至重度精神发育迟滞;急性自杀倾向;重度合并症。符合入选标准的患者被随机分配到两种条件之一（CBMT + TAU或MAPE + TAU）。目前，已从莱茵-美因河地区和图林根州的12家精神病医院和心理科的门诊部招募了186名患者。该试验的资金目前包括评估两种治疗形式对治疗后仅一年内MDE复发/复发发生率的影响。没有这样的长期随访的大型和良好的控制试验可用。但在复发性抑郁症中，长期复发预防是最相关的结局标准。

While recurrent depression is an established indicator for pharmacological maintenance treatment, empirical support for the long-term benefit of additional cognitive-behavioral therapy in continuation or maintenance treatment is lacking. The major goal of the study is to compare the long-term outcome of cognitive-behavioural maintenance therapy (CBMT) plus pharmacological continuation/maintenance treatment (treatment as usual, TAU) versus manualized psychoeducation (MAPE) plus TAU for out-patients with recurrent depression in a multi-centre, controlled, randomised trial. Patients meeting the following criteria were included: diagnosis of recurrent depressive disorder (≥ 3 major depressive episodes, MDE), currently in remission; complete remission over 8 weeks after acute treatment of MDE; at least one index depressive episode in the 12 months prior to the intervention. Exclusion criteria were: organic disorder; psychological / behavioural disorders caused by psychotropic substances; schizophrenia; schizoaffective disorder; bipolar depression; moderate to severe mental retardation; acute suicidality; severe comorbid medical condition. Patients meeting the inclusion criteria were randomly assigned to one of the two conditions (CBMT plus TAU or MAPE plus TAU). Currently, 186 patients have been recruited from 12 outpatient clinics of psychiatric hospitals and psychological departments in the Rhine-Main region and Thuringia. Funding of the trial presently covers an assessment of the effects of both treatment forms on the occurrence of relapse/recurrence of MDE for a period of only one year following treatment. There are no such long-term follow-ups of large and well controlled trails available. But in recurrent depression long-term relapse prevention is the most relevant outcome criteria.