Bedi N, Chilvers C, Churchill R, Dewey M, Duggan C, Fielding K, Gretton V, Miller P, Harrison G, Lee A, Williams I
Department of Psychiatry, Queen's University Medical Centre, University of Nottingham, UK.
Br J Psychiatry. 2000 Oct;177:312-8. doi: 10.1192/bjp.177.4.312.
There is a mismatch between the wish of a patient with depression to have counselling and the prescription of antidepressants by the doctor.
To determine whether counselling is as effective as antidepressants for depression in primary care and whether allowing patients to choose their treatment affects their response.
A partially randomised preference trial, with patients randomised to either antidepressants or counselling or given their choice of either treatment. The treatment and follow-up were identical in the randomised and patient preference arms.
There were 103 randomised and 220 preference patients in the trial. We found: no differences in the baseline characteristics of the randomised and preference groups; that the two treatments were equally effective at 8 weeks, both for the randomised group and when the randomised and patient preference groups for a particular treatment were combined; and that expressing a preference for either treatment conferred no additional benefit on outcome.
These data challenge several assumptions about the most appropriate treatment for depression in a primary care setting.
抑郁症患者希望接受咨询与医生开具抗抑郁药之间存在不匹配。
确定在初级保健中咨询对于抑郁症是否与抗抑郁药同样有效，以及允许患者选择治疗方式是否会影响其反应。
一项部分随机化的偏好试验，患者被随机分配至抗抑郁药组或咨询组，或者可选择其中一种治疗方式。随机组和患者偏好组的治疗及随访相同。
试验中有103名随机分配的患者和220名有偏好的患者。我们发现：随机组和偏好组的基线特征无差异；两种治疗在8周时同样有效，无论是随机组，还是将特定治疗的随机组和患者偏好组合并计算时；而且，对任何一种治疗方式表达偏好对治疗结果并无额外益处。
这些数据对在初级保健环境中治疗抑郁症的最恰当方式的若干假设提出了质疑。
