Cuijpers Pim, Dekker Jack, Hollon Steven D, Andersson Gerhard
Department of Clinical Psychology, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands.
J Clin Psychiatry. 2009 Sep;70(9):1219-29. doi: 10.4088/JCP.09r05021.
A considerable number of studies has examined whether adding psychotherapy to pharmacotherapy results in stronger effects than pharmacotherapy alone. However, earlier meta-analyses in this field have included only a limited number of available studies and did not conduct extended subgroup analyses to examine possible sources of heterogeneity.
We used a database derived from a comprehensive literature search in PubMed, PsycINFO, EMBASE, and the Cochrane Central Register of Controlled Trials for studies published from 1966 to January 2008 that examined the psychological treatment of depression. The abstracts of these studies were identified by combining terms indicative of psychological treatment and depression.
We included randomized trials in which the effects of a pharmacologic treatment were compared to the effects of a combined pharmacologic and psychological treatment in adults with a depressive disorder.
For each of the studies, we calculated a standardized mean effect size indicating the difference between pharmacotherapy and the combined treatment at posttest. We also coded major characteristics of the population, the interventions, and the quality and design of the study.
Twenty-five randomized trials, with a total of 2,036 patients, were included. A mean effect size of d = 0.31 (95% CI, 0.20 approximately 0.43) was found for the 25 included studies, indicating a small effect in favor of the combined treatment over pharmacotherapy alone. Studies aimed at patients with dysthymia resulted in significantly lower effect sizes compared to studies aimed at patients with major depression, a finding that suggests that the added value of psychotherapy is less in patients with dysthymia. The dropout rate was significantly lower in the combined treatment group compared to the pharmacotherapy only group (OR = 0.65; 95% CI, 0.50 approximately 0.83).
Psychotherapy seems to have an additional value compared to pharmacotherapy alone for depression.
大量研究探讨了在药物治疗基础上联合心理治疗是否比单纯药物治疗效果更佳。然而，该领域早期的荟萃分析仅纳入了有限数量的现有研究，且未进行扩展的亚组分析以探究异质性的可能来源。
我们使用了一个数据库，该数据库来自于对1966年至2008年1月期间发表在PubMed、PsycINFO、EMBASE以及Cochrane对照试验中央注册库上的研究进行的全面文献检索，这些研究涉及抑郁症的心理治疗。通过组合表示心理治疗和抑郁症的术语来识别这些研究的摘要。
我们纳入了随机试验，这些试验比较了药物治疗与药物联合心理治疗对患有抑郁症的成年人的效果。
对于每项研究，我们计算了一个标准化平均效应量，以表明药物治疗与联合治疗在测试后之间的差异。我们还对研究人群的主要特征、干预措施以及研究的质量和设计进行了编码。
纳入了25项随机试验，共2036名患者。对于这25项纳入研究，发现平均效应量d = 0.31（95%置信区间，0.20至0.43），表明联合治疗相对于单纯药物治疗有较小的优势。与针对重度抑郁症患者的研究相比，针对心境恶劣障碍患者的研究得出的效应量显著更低，这一发现表明心理治疗在心境恶劣障碍患者中的附加价值较小。联合治疗组的脱落率显著低于仅药物治疗组（比值比 = 0.65；95%置信区间，0.50至0.83）。
与单纯药物治疗相比，心理治疗对抑郁症似乎具有附加价值。
