Blumenthal James A, Babyak Michael A, Doraiswamy P Murali, Watkins Lana, Hoffman Benson M, Barbour Krista A, Herman Steve, Craighead W Edward, Brosse Alisha L, Waugh Robert, Hinderliter Alan, Sherwood Andrew
Department of Psychiatry and Behavioral Sciences, Box 3119, Duke University Medical Center, Durham, NC, USA.
Psychosom Med. 2007 Sep-Oct;69(7):587-96. doi: 10.1097/PSY.0b013e318148c19a. Epub 2007 Sep 10.
To assess whether patients receiving aerobic exercise training performed either at home or in a supervised group setting achieve reductions in depression comparable to standard antidepressant medication (sertraline) and greater reductions in depression compared to placebo controls.
Between October 2000 and November 2005, we performed a prospective, randomized controlled trial (SMILE study) with allocation concealment and blinded outcome assessment in a tertiary care teaching hospital. A total of 202 adults (153 women; 49 men) diagnosed with major depression were assigned randomly to one of four conditions: supervised exercise in a group setting; home-based exercise; antidepressant medication (sertraline, 50-200 mg daily); or placebo pill for 16 weeks. Patients underwent the structured clinical interview for depression and completed the Hamilton Depression Rating Scale (HAM-D).
After 4 months of treatment, 41% of the participants achieved remission, defined as no longer meeting the criteria for major depressive disorder (MDD) and a HAM-D score of <8. Patients receiving active treatments tended to have higher remission rates than the placebo controls: supervised exercise = 45%; home-based exercise = 40%; medication = 47%; placebo = 31% (p = .057). All treatment groups had lower HAM-D scores after treatment; scores for the active treatment groups were not significantly different from the placebo group (p = .23).
The efficacy of exercise in patients seems generally comparable with patients receiving antidepressant medication and both tend to be better than the placebo in patients with MDD. Placebo response rates were high, suggesting that a considerable portion of the therapeutic response is determined by patient expectations, ongoing symptom monitoring, attention, and other nonspecific factors.
评估在家中或在有监督的小组环境中进行有氧运动训练的患者，其抑郁症状的减轻程度是否与标准抗抑郁药物（舍曲林）相当，以及与安慰剂对照组相比，抑郁症状的减轻程度是否更大。
在2000年10月至2005年11月期间，我们在一家三级护理教学医院进行了一项前瞻性、随机对照试验（SMILE研究），采用了分配隐藏和盲法结局评估。共有202名被诊断为重度抑郁症的成年人（153名女性；49名男性）被随机分配到以下四种情况之一：在有监督的小组环境中进行运动；在家中进行运动；抗抑郁药物治疗（舍曲林，每日50 - 200毫克）；或服用安慰剂丸，为期16周。患者接受了抑郁症的结构化临床访谈，并完成了汉密尔顿抑郁量表（HAM - D）。
治疗4个月后，41%的参与者达到缓解，定义为不再符合重度抑郁症（MDD）的标准且HAM - D评分<8。接受积极治疗的患者缓解率往往高于安慰剂对照组：有监督的运动组 = 45%；在家中进行运动组 = 40%；药物治疗组 = 47%；安慰剂组 = 31%（p = 0.057）。所有治疗组治疗后的HAM - D评分均较低；积极治疗组的评分与安慰剂组无显著差异（p = 0.23）。
运动对患者的疗效似乎总体上与接受抗抑郁药物治疗的患者相当，并且在MDD患者中两者往往都比安慰剂效果更好。安慰剂反应率较高，表明相当一部分治疗反应是由患者期望、持续的症状监测、关注和其他非特异性因素决定的。
