Thase M E, Friedman E S
University of Pittsburgh School of Medicine, Western Psychiatric Institute, PA 15213, USA.
J Affect Disord. 1999 Jul;54(1-2):1-19. doi: 10.1016/s0165-0327(99)00033-6.
The treatment of severe depression with psychotherapy, alone, is controversial. In this paper, we review the historical, conceptual, and empirical contexts of this controversy. In addition to work by others, we review recent work from our institute which has examined the psychobiological substrates of response to treatment in depressive subtypes. We examine the traditional categories that describe severe depressions. The features and psychobiological correlates of melancholia are discussed, as is the relationship between melancholia and aging. Research on treatment of melancholia and other severe depressive states with psychotherapies such as cognitive behavior therapy (CBT) and interpersonal psychotherapy (IPT) is reviewed in detail. We conclude that although some melancholic patients are responsive to IPT or CBT, there is not yet compelling evidence that melancholic patients respond to psychotherapy as well as they do to medications. The potentially mediating effects of hypercortisolism, alterations of sleep neurophysiology, and disturbances of information processing and regional cerebral metabolism represent fertile grounds for future investigation. We discuss the practical implications of the literature reviewed.
单独使用心理治疗来治疗重度抑郁症存在争议。在本文中，我们回顾了这一争议的历史、概念和实证背景。除了他人的研究工作，我们还回顾了我们研究所最近的研究成果，该研究考察了抑郁亚型对治疗反应的心理生物学基础。我们审视了描述重度抑郁症的传统类别。讨论了 melancholia 的特征及其心理生物学关联，以及 melancholia 与衰老之间的关系。详细回顾了使用认知行为疗法（CBT）和人际心理治疗（IPT）等心理治疗方法治疗 melancholia 和其他重度抑郁状态的研究。我们得出结论，虽然一些 melancholic 患者对 IPT 或 CBT 有反应，但尚无确凿证据表明 melancholic 患者对心理治疗的反应与对药物治疗的反应一样好。高皮质醇血症的潜在中介作用、睡眠神经生理学的改变以及信息处理和局部脑代谢的紊乱是未来研究的丰富领域。我们讨论了所综述文献的实际意义。
