Cuijpers Pim, van Straten Annemieke, van Oppen Patricia, Andersson Gerhard
Department of Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands.
J Clin Psychiatry. 2008 Nov;69(11):1675-85; quiz 1839-41. doi: 10.4088/jcp.v69n1102. Epub 2008 Aug 12.
A large number of studies suggest that both psychological and pharmacologic therapies are effective in the treatment of mild-to-moderate depressive disorders. Whether both types of intervention are equally effective has not been established definitively.
A database was developed through a comprehensive literature search (from 1966 to May 2007) in which 6947 abstracts in PubMed (1244 abstracts), PsycINFO (1736), EMBASE (1911), and the Cochrane Central Register of Controlled Trials (2056) were examined. Abstracts were identified by combining terms indicative of psychological treatment and depression (both MeSH terms and text words). For this database, the primary studies from 22 meta-analyses of psychological treatment for depression were also collected.
For the current study, the abstracts of 832 studies were examined.
Thirty randomized trials were included in a meta-analysis that compared the effects of a psychological treatment for 3178 adults with a diagnosed depressive disorder (major depressive disorder, dysthymia, minor depressive disorder) with the effects of a pharmacologic treatment.
In studies of patients with dysthymia, pharmacotherapy was significantly more effective than psychotherapy (d = -0.28, 95% CI = -0.47 to -0.10). In patients with major depressive disorder, treatments with selective serotonin reuptake inhibitors (SSRIs) were significantly more effective than psychological treatments, while treatment with other antidepressants did not differ significantly. Subgroup and metaregression analyses did not show that pretest severity of depressive symptoms was associated with differential effects of psychological and pharmacologic treatments of major depressive disorder. Dropout rates were smaller in psychological interventions compared with pharmacologic treatments (odds ratio = 0.66, 95% CI = 0.47 to 0.92).
Pharmacologic treatments may be more effective than psychological interventions in the treatment of dysthymia. Pharmacologic treatment with SSRIs may also be more effective in the treatment of major depressive disorder, although these differences are small and probably have little meaning from a clinical point of view. We can conclude that both psychological and pharmacologic therapies are effective in the treatment of depressive disorders and that each has its own merits.
大量研究表明，心理治疗和药物治疗对轻至中度抑郁症均有效。两种干预方式是否同样有效尚未明确确定。
通过全面的文献检索（从1966年至2007年5月）建立了一个数据库，其中检查了PubMed（1244篇摘要）、PsycINFO（1736篇）、EMBASE（1911篇）和Cochrane对照试验中央注册库（2056篇）中的6947篇摘要。通过组合表示心理治疗和抑郁症的术语（包括医学主题词和文本词）来识别摘要。对于该数据库，还收集了22项抑郁症心理治疗荟萃分析的原始研究。
对于当前研究，检查了832项研究的摘要。
一项荟萃分析纳入了30项随机试验，比较了针对3178名被诊断为抑郁症（重度抑郁症、心境恶劣障碍、轻度抑郁症）的成年人进行心理治疗与药物治疗的效果。
在心境恶劣障碍患者的研究中，药物治疗显著比心理治疗更有效（d = -0.28，95%置信区间 = -0.47至-0.10）。在重度抑郁症患者中，选择性5-羟色胺再摄取抑制剂（SSRI）治疗显著比心理治疗更有效，而其他抗抑郁药治疗则无显著差异。亚组和元回归分析未显示抑郁症状的预测试严重程度与重度抑郁症心理和药物治疗的差异效果相关。与药物治疗相比，心理干预的脱落率较小（优势比 = 0.66，95%置信区间 = 0.47至0.92）。
在治疗心境恶劣障碍方面，药物治疗可能比心理干预更有效。SSRI药物治疗在治疗重度抑郁症方面也可能更有效，尽管这些差异很小，从临床角度来看可能意义不大。我们可以得出结论，心理治疗和药物治疗对抑郁症均有效，且各有其优点。
