Goldberg D, Privett M, Ustun B, Simon G, Linden M
Institute of Psychiatry, London.
Br J Gen Pract. 1998 Dec;48(437):1840-4.
This study reports the responses of patients with confirmed depressive illnesses to different treatments in the WHO Mental Disorders in General Health Care study, conducted in 15 cities around the world.
To discover how depressions recognized by the doctor compare with unrecognized depressions, both in terms of the initial illnesses and their outcomes, and to compare the outcomes of those depressions treated with antidepressants with those treated with daytime sedatives.
The design of the study was naturalistic, in that physicians were free to treat patients however they wished. Patients with confirmed depressive illnesses were assigned to four groups: treatment with an antidepressant; treatment with a daytime sedative (usually a benzodiazepine); patients recognized as having depression by the physician but were not offered drug treatment; and patients unrecognized as having depression by their physician.
Both groups receiving drugs had illnesses of equal severity, were demographically similar to one another, and had similar previous histories of depression. Those receiving antidepressants had significantly fewer overall symptoms and fewer suicidal thoughts than those treated with sedatives. By the end of one year, differences between the groups had disappeared: patients not given drugs had milder illnesses but did significantly better than those receiving drugs, both in terms of symptoms lost and their diagnostic status. Unrecognized depressions were less severe than recognized depressions, and had a similar course over the year.
Patients receiving antidepressants were better in terms of overall symptoms and suicidal thoughts than those treated with sedatives at three months, but this advantage does not persist. Depression emerges as a chronic disorder at one-year follow-up--about 60% of those treated with drugs, and 50% of the milder depressions, still meet criteria for caseness. The study does not support the view that failure to recognize depression has serious adverse consequences, but, in view of the poor prognosis of depression, measures to improve compliance with treatment would appear to be indicated.
本研究报告了在世界15个城市开展的世界卫生组织“普通医疗中的精神障碍”研究中确诊为抑郁症的患者对不同治疗方法的反应。
从初始疾病及其转归方面，探究医生诊断出的抑郁症与未被诊断出的抑郁症之间的差异，并比较使用抗抑郁药治疗的抑郁症患者与使用日间镇静剂治疗的抑郁症患者的转归情况。
该研究采用自然主义设计，即医生可根据自己的意愿自由治疗患者。确诊为抑郁症的患者被分为四组：使用抗抑郁药治疗；使用日间镇静剂（通常为苯二氮䓬类药物）治疗；被医生诊断为患有抑郁症但未接受药物治疗的患者；未被医生诊断为患有抑郁症的患者。
两组接受药物治疗的患者病情严重程度相同，人口统计学特征相似，既往抑郁症病史也相似。与接受镇静剂治疗的患者相比，接受抗抑郁药治疗的患者总体症状明显更少，自杀念头也更少。到一年结束时，组间差异消失：未接受药物治疗的患者病情较轻，但在症状缓解和诊断状态方面均比接受药物治疗的患者表现更好。未被诊断出的抑郁症比被诊断出的抑郁症病情轻，且在这一年中的病程相似。
在三个月时，接受抗抑郁药治疗的患者在总体症状和自杀念头方面比接受镇静剂治疗的患者情况更好，但这种优势并未持续。在一年的随访中，抑郁症呈现为一种慢性疾病——约60%接受药物治疗的患者以及50%病情较轻的抑郁症患者仍符合病例标准。该研究不支持未诊断出抑郁症会产生严重不良后果这一观点，但是，鉴于抑郁症预后较差，似乎需要采取措施提高治疗依从性。
