Spielmans Glen I, Berman Margit I, Usitalo Ashley N
Department of Psychology, Metropolitan State University, St. Paul, MN, USA.
J Nerv Ment Dis. 2011 Mar;199(3):142-9. doi: 10.1097/NMD.0b013e31820caefb.
Most meta-analyses have concluded that psychotherapy and pharmacotherapy yield roughly similar efficacy in the short-term treatment of depression, with psychotherapy showing some advantage at long-term follow-up. However, a recent meta-analysis found that selective serotonin reuptake inhibitors medications were superior to psychotherapy in the short-term treatment of depression. To incorporate results of several recent trials into the meta-analytic literature, we conducted a meta-analysis of trials which directly compared psychotherapy to second-generation antidepressants (SGAs). Variables potentially moderating the quality of psychotherapy or medication delivery were also examined, to allow the highest quality comparison of both types of intervention. Bona fide psychotherapies showed equivalent efficacy in the short-term and slightly better efficacy on depression rating scales at follow-up relative to SGA. Non-bona fide therapies had significantly worse short-term outcomes than medication (d = 0.58). No significant differences emerged between treatments in terms of response or remission rates, but non-bona fide therapies had significantly lower rates of study completion than medication (odds ratio = 0.55). Bona fide psychotherapy appears as effective as SGAs in the short-term treatment of depression, and likely somewhat more effective than SGAs in the longer-term management of depressive symptoms.
大多数荟萃分析得出结论，在抑郁症的短期治疗中，心理治疗和药物治疗产生的疗效大致相似，心理治疗在长期随访中显示出一些优势。然而，最近一项荟萃分析发现，在抑郁症的短期治疗中，选择性5-羟色胺再摄取抑制剂类药物优于心理治疗。为了将最近几项试验的结果纳入荟萃分析文献，我们对直接比较心理治疗与第二代抗抑郁药（SGA）的试验进行了荟萃分析。还检查了可能影响心理治疗或药物治疗质量的变量，以便对两种干预措施进行最高质量的比较。正宗心理治疗在短期内显示出同等疗效，在随访时相对于SGA在抑郁评定量表上的疗效略好。非正宗治疗的短期结果明显比药物治疗差（d = 0.58）。在反应率或缓解率方面，治疗之间没有显著差异，但非正宗治疗的研究完成率明显低于药物治疗（优势比 = ０.55）。正宗心理治疗在抑郁症的短期治疗中似乎与SGA一样有效，并且在抑郁症症状的长期管理中可能比SGA更有效。
