Imel Zac E, Malterer Melanie B, McKay Kevin M, Wampold Bruce E
Department of Counseling Psychology, 321 Education Building, University of Wisconsin-Madison, 1000 Bascom Mall Madison, WI 53706, United States.
J Affect Disord. 2008 Oct;110(3):197-206. doi: 10.1016/j.jad.2008.03.018. Epub 2008 May 5.
There remains considerable disagreement regarding the relative efficacy of psychotherapy and medication across types of depression.
We used random effects meta-analysis to examine the relative efficacy of psychotherapy vis-à-vis medication at post-treatment and follow-up. We also estimated the relative efficacy of continued medication versus discontinued psychotherapy. As twenty-eight studies (39 effects, n=3,381) met inclusion criteria, we were able to conduct an adequately powered test of between-study heterogeneity and examine if the type of depression influenced relative efficacy.
Psychotherapy and medication were not significantly different at post-treatment, however effect sizes were not consistent. Although there was no association between severity and relative efficacy, a small but significant advantage for medications in the treatment of dysthymia did emerge. However, psychotherapy showed a significant advantage over medication at follow-up and this advantage was positively associated with length of follow-up. Moreover, discontinued acute phase psychotherapy did not differ from continued medication at follow-up.
Limitations included relatively fewer studies of severe and chronic depression, as well as dysthymia. In addition, only a minority of studies reported follow-up data.
Our results indicated that both psychotherapy and medication are viable treatments for unipolar depression and that psychotherapy may offer a prophylactic effect not provided by medication. However, our analyses diverged from previous findings in that effects were not consistent and medication was significantly more efficacious than psychotherapy in the treatment of dysthymia.
关于心理治疗和药物治疗在不同类型抑郁症中的相对疗效，仍存在相当大的分歧。
我们采用随机效应荟萃分析来检验心理治疗与药物治疗在治疗后及随访时的相对疗效。我们还估计了持续药物治疗与停止心理治疗的相对疗效。由于28项研究（39个效应，n = 3381）符合纳入标准，我们能够对研究间异质性进行有足够效力的检验，并考察抑郁症类型是否会影响相对疗效。
治疗后心理治疗和药物治疗无显著差异，但效应量不一致。虽然严重程度与相对疗效之间没有关联，但在治疗心境恶劣障碍方面，药物治疗确实显示出微小但显著的优势。然而，在随访时心理治疗比药物治疗显示出显著优势，且这一优势与随访时间长度呈正相关。此外，在随访时，停止急性期心理治疗与持续药物治疗没有差异。
局限性包括对重度和慢性抑郁症以及心境恶劣障碍的研究相对较少。此外，只有少数研究报告了随访数据。
我们的结果表明，心理治疗和药物治疗都是单相抑郁症的可行治疗方法，并且心理治疗可能提供药物治疗所没有的预防作用。然而，我们的分析与先前的研究结果不同，因为效应不一致，且在治疗心境恶劣障碍方面药物治疗比心理治疗显著更有效。
