Kratochvil Christopher, Emslie Graham, Silva Susan, McNulty Steve, Walkup John, Curry John, Reinecke Mark, Vitiello Benedetto, Rohde Paul, Feeny Nora, Casat Charles, Pathak Sanjeev, Weller Elizabeth, May Diane, Mayes Taryn, Robins Michele, March John
University of Nebraska Medical Center NE 68198-5581, USA.
J Am Acad Child Adolesc Psychiatry. 2006 Dec;45(12):1412-8. doi: 10.1097/01.chi.0000237710.73755.14.
To examine the time to response for both pharmacotherapy and psychotherapy in the Treatment for Adolescents with Depression Study (TADS).
Adolescents (N = 439, ages 12 to 17 years) with major depressive disorder were randomized to fluoxetine (FLX), cognitive-behavioral therapy (CBT), their combination (COMB), or pill placebo (PBO). Defining response as very much improved or much improved on the Clinical Global Impression-Improvement Scale (CGI-I), survival analyses using Cox proportional hazards models, and Kaplan-Meier curves were conducted to evaluate time to first response and time to stable response for subjects receiving pharmacotherapy (COMB, FLX, PBO) as well as for subjects receiving CBT (COMB, CBT). Direct comparisons between pharmacotherapy and CBT were not made because of differences in visit schedules.
Based on pharmacotherapist CGI-I scores, COMB and FLX showed faster onset of benefit than PBO on time to response and time to stable response (p < .001), and COMB was faster than FLX on time to stable response (p = .034). The probability of sustained early response was approximately threefold greater for COMB than PBO, twofold greater for FLX than PBO, and 1.5-fold greater for COMB than FLX. On the psychotherapist CGI-I scores, both first response and stable response occurred faster in COMB than CBT (p < .001), with a probability of sustained early response approximately threefold greater for COMB than CBT.
In the acute treatment of depressed adolescents, FLX and COMB accelerate response relative to PBO, and COMB accelerates response relative to CBT alone.
在青少年抑郁症治疗研究（TADS）中，考察药物治疗和心理治疗的起效时间。
将患有重度抑郁症的青少年（N = 439，年龄12至17岁）随机分为氟西汀（FLX）组、认知行为疗法（CBT）组、二者联合（COMB）组或安慰剂（PBO）组。将临床总体印象改善量表（CGI - I）上评定为“明显改善”或“显著改善”定义为有反应，使用Cox比例风险模型进行生存分析，并绘制Kaplan - Meier曲线，以评估接受药物治疗（COMB、FLX、PBO）的受试者以及接受CBT治疗（COMB、CBT）的受试者的首次反应时间和稳定反应时间。由于访视安排不同，未对药物治疗和CBT进行直接比较。
根据药物治疗师的CGI - I评分，在反应时间和稳定反应时间方面，COMB组和FLX组比PBO组起效更快（p <.001），在稳定反应时间方面，COMB组比FLX组更快（p =.034）。COMB组持续早期反应的概率比PBO组大约高三倍，FLX组比PBO组高两倍，COMB组比FLX组高1.5倍。根据心理治疗师的CGI - I评分，COMB组的首次反应和稳定反应均比CBT组更快（p <.001），COMB组持续早期反应的概率比CBT组大约高三倍。
在抑郁症青少年的急性治疗中，相对于PBO，FLX和COMB可加速反应，相对于单独的CBT，COMB可加速反应。
