Foa E B, Kozak M J, Steketee G S, McCarthy P R
Medical College of Pennsylvania, Philadelphia 19129.
Br J Clin Psychol. 1992 Sep;31(3):279-92. doi: 10.1111/j.2044-8260.1992.tb00995.x.
The efficacy of behavioural treatment of obsessive-compulsive disorder (OCD) has been well documented. However, severely depressed OCD patients showed fewer short- and long-term benefits than less depressed patients. The present study tested the hypothesis that reduction of depression by imipramine prior to behaviour therapy would enhance the effects of behavioural therapy on depressed OC patients. Thirty-eight patients were divided into highly and mildly depressed groups according to their scores on the Beck Depression Inventory; half of each group received imipramine and half received placebo for six weeks. All patients then received three weeks of daily behavioural treatment (exposure and response prevention) followed by 12 weekly sessions of supportive psychotherapy. Results indicated that although imipramine improved depressive symptoms in depressed patients, it did not affect OC symptoms. Behaviour therapy markedly reduced OC symptoms but, contrary to our hypothesis, imipramine did not potentiate the effects of behaviour therapy. No differences between highly depressed and mildly depressed patients on OC symptoms were found in their responses to behavioural or supportive therapy.
强迫症（OCD）行为治疗的疗效已有充分文献记载。然而，与抑郁程度较轻的患者相比，重度抑郁的强迫症患者在短期和长期内受益更少。本研究检验了这样一个假设：在行为治疗前使用丙咪嗪减轻抑郁症状，会增强行为治疗对抑郁的强迫症患者的效果。根据贝克抑郁量表的得分，38名患者被分为高度抑郁组和轻度抑郁组；每组各有一半患者接受为期六周的丙咪嗪治疗，另一半接受安慰剂治疗。所有患者随后接受为期三周的每日行为治疗（暴露与反应阻止法），之后再进行12次每周一次的支持性心理治疗。结果表明，虽然丙咪嗪改善了抑郁患者的抑郁症状，但并未影响强迫症状。行为治疗显著减轻了强迫症状，但与我们的假设相反，丙咪嗪并未增强行为治疗的效果。在对行为治疗或支持性治疗的反应方面，高度抑郁患者和轻度抑郁患者在强迫症状上未发现差异。
