Gerson S, Belin T R, Kaufman A, Mintz J, Jarvik L
Department of Psychiatry and Biobehavioral Sciences, UCLA Neuropsychiatric Institute and Hospital, Los Angeles, CA 90024-1759, USA.
Harv Rev Psychiatry. 1999 May-Jun;7(1):1-28.
A meta-analysis was carried out to evaluate data published between January 1974 and February 1998 comparing rates of treatment response and tolerability of pharmacological and psychological treatments for depression in persons over age 55. Drugs (tricyclic antidepressants, selective serotonin-reuptake inhibitors, and a mixed group of other drugs) were significantly better than placebo, with an average reduction in symptom severity of 48.0% versus 31.3% (analysis weighted by sample size; 50.6% vs. 21.4% unweighted). No single drug or group of drugs was superior in terms of efficacy, and no statistically significant differences in tolerability emerged between tricyclic antidepressants and selective serotonin-reuptake inhibitors, whether measured by total dropouts or by dropouts due to side effects. Compared to the data on pharmacological treatments, those for outcomes of psychological treatments are very limited. Existing data indicate that cognitive-behavioral, behavioral, and psychodynamic therapies are significantly better than placebo. In the current meta-analysis, response rates to these nondrug therapies did not differ significantly from those observed with tricyclic antidepressants or selective serotonin-reuptake inhibitors, but direct comparison data are insufficient for firm conclusions to be drawn about comparative efficacy. It is possible, even likely, that not only different subtypes of depression but also different patients vary in their treatment responses. However, lack of adequate data prevented the current meta-analysis from addressing these issues. Rigorously designed prospective studies on treatment outcome, taking into account the above differences, are urgently needed to provide robust data on which to base clinical recommendations for the treatment of depression in older patients.
进行了一项荟萃分析，以评估1974年1月至1998年2月期间发表的数据，这些数据比较了55岁以上人群中抑郁症药物治疗和心理治疗的治疗反应率及耐受性。药物（三环类抗抑郁药、选择性5-羟色胺再摄取抑制剂以及其他药物的混合组）显著优于安慰剂，症状严重程度平均降低48.0%，而安慰剂为31.3%（按样本量加权分析；未加权时为50.6%对21.4%）。就疗效而言，没有单一药物或药物组更具优势，三环类抗抑郁药和选择性5-羟色胺再摄取抑制剂在耐受性方面也没有出现统计学上的显著差异，无论是通过总退出率还是因副作用导致的退出率来衡量。与药物治疗的数据相比，心理治疗结果的数据非常有限。现有数据表明，认知行为疗法、行为疗法和心理动力疗法显著优于安慰剂。在当前的荟萃分析中，这些非药物疗法的反应率与三环类抗抑郁药或选择性5-羟色胺再摄取抑制剂观察到的反应率没有显著差异，但直接比较数据不足以就比较疗效得出确凿结论。不仅不同类型的抑郁症，而且不同患者的治疗反应都有可能甚至很可能存在差异。然而，缺乏足够的数据使得当前的荟萃分析无法解决这些问题。迫切需要考虑上述差异的、设计严谨的前瞻性治疗结果研究，以提供有力的数据，作为老年患者抑郁症治疗临床建议的依据。
