Parikh Sagar V, Segal Zindel V, Grigoriadis Sophie, Ravindran Arun V, Kennedy Sidney H, Lam Raymond W, Patten Scott B
University of Toronto, Canada.
J Affect Disord. 2009 Oct;117 Suppl 1:S15-25. doi: 10.1016/j.jad.2009.06.042. Epub 2009 Aug 13.
In 2001, the Canadian Psychiatric Association and the Canadian Network for Mood and Anxiety Treatments (CANMAT) partnered to produce evidence-based clinical guidelines for the treatment of depressive disorders. A revision of these guidelines was undertaken by CANMAT in 2008-2009 to reflect advances in the field. This article, one of five in the series, reviews new studies of psychotherapy in the acute and maintenance phase of MDD, including computer-based and telephone-delivered psychotherapy.
The CANMAT guidelines are based on a question-answer format to enhance accessibility to clinicians. Evidence-based responses are based on updated systematic reviews of the literature and recommendations are graded according to the Level of Evidence, using pre-defined criteria. Lines of Treatment are identified based on criteria that included evidence and expert clinical support.
Cognitive-Behavioural Therapy (CBT) and Interpersonal Therapy (IPT) continue to have the most evidence for efficacy, both in acute and maintenance phases of MDD, and have been studied in combination with antidepressants. CBT is well studied in conjunction with computer-delivered methods and bibliotherapy. Behavioural Activation and Cognitive-Behavioural Analysis System of Psychotherapy have significant evidence, but need replication. Newer psychotherapies including Acceptance and Commitment Therapy, Motivational Interviewing, and Mindfulness-Based Cognitive Therapy do not yet have significant evidence as acute treatments; nor does psychodynamic therapy.
Although many forms of psychotherapy have been studied, relatively few types have been evaluated for MDD in randomized controlled trials. Evidence about the combination of different types of psychotherapy and antidepressant medication is also limited despite widespread use of these therapies concomitantly.
CBT and IPT are the only first-line treatment recommendations for acute MDD and remain highly recommended for maintenance. Both computer-based and telephone-delivered psychotherapy--primarily studied with CBT and IPT--are useful second-line recommendations. Where feasible, combined antidepressant and CBT or IPT are recommended as first-line treatments for acute MDD.
2001年，加拿大精神科协会与加拿大情绪与焦虑治疗网络（CANMAT）合作制定了抑郁症治疗的循证临床指南。CANMAT在2008 - 2009年对这些指南进行了修订，以反映该领域的进展。本文是该系列的五篇文章之一，回顾了关于中度抑郁障碍（MDD）急性期和维持期心理治疗的新研究，包括基于计算机和电话提供的心理治疗。
CANMAT指南采用问答形式，以提高临床医生的可及性。循证回答基于对文献的更新系统评价，推荐意见根据证据水平使用预定义标准进行分级。治疗方案根据包括证据和专家临床支持在内的标准确定。
认知行为疗法（CBT）和人际疗法（IPT）在MDD的急性期和维持期继续拥有最多的疗效证据，并且已经与抗抑郁药联合进行了研究。CBT与计算机辅助方法和自助疗法结合的研究很充分。行为激活和认知行为分析心理治疗系统有重要证据，但需要重复验证。包括接纳与承诺疗法、动机性访谈和基于正念的认知疗法在内的较新心理疗法作为急性治疗方法尚无重要证据；心理动力疗法也是如此。
尽管已经对多种形式的心理治疗进行了研究，但在随机对照试验中针对MDD评估的类型相对较少。尽管这些疗法同时广泛使用，但关于不同类型心理治疗与抗抑郁药物联合使用的证据也有限。
CBT和IPT是急性MDD的唯一一线治疗推荐，维持期也强烈推荐使用。基于计算机和电话提供的心理治疗——主要是与CBT和IPT结合进行研究——是有用的二线推荐。在可行的情况下，推荐联合使用抗抑郁药和CBT或IPT作为急性MDD的一线治疗方法。
