认知行为疗法与药物治疗在抑郁症与焦虑症中的相对疗效：药物治疗对抑郁症是否稍好一些，而认知行为疗法对焦虑症是否稍好一些？

Relative effects of CBT and pharmacotherapy in depression versus anxiety: is medication somewhat better for depression, and CBT somewhat better for anxiety?

机构信息

VA Puget Sound Health Care System, Seattle, Washington, USA.

出版信息

Depress Anxiety. 2011 Jul;28(7):560-7. doi: 10.1002/da.20829. Epub 2011 May 23.

DOI:10.1002/da.20829

PMID:21608087

Abstract

BACKGROUND

Little is known about whether cognitive behavioral therapy (CBT) or pharmacotherapy is relatively more advantageous for depressive versus anxiety disorders.

METHODS

We conducted a meta-analysis wherein we searched electronic databases and references to select randomized controlled studies comparing CBT and pharmacotherapy, with or without placebo, in adults with major depressive or anxiety disorders. The primary effect size was calculated from disorder-specific outcome measures as the difference between CBT and pharmacotherapy outcomes (i.e., positive effect size favors CBT; negative effect size favors pharmacotherapy).

RESULTS

Twenty-one anxiety (N = 1,266) and twenty-one depression (N = 2,027) studies comparing medication to CBT were included. Including all anxiety disorders, the overall effect size was.25 (95% CI: -0.02, 0.55, P =.07). Effects for panic disorder significantly favored CBT over medications (.50, 95% CI: 0.02, 0.98). Obsessive-compulsive disorder showed similar effects-sizes, though not statistically significant (.49, 95% CI: -0.11, 1.09). Medications showed a nonsignificant advantage for social anxiety disorder (-.22, 95% CI: -0.50, 0.06). The overall effect size for depression studies was.05 (95% CI: -0.09, 0.19), with no advantage for medications or CBT. Pooling anxiety disorder and depression studies, the omnibus comparison of the relative difference between anxiety and depression in effectiveness for CBT versus pharmacotherapy pointed to a nonsignificant advantage for CBT in anxiety versus depression (B =.14, 95% CI: -0.14, 0.43).

CONCLUSIONS

On balance, the evidence presented here indicates that there are at most very modest differences in effects of CBT versus pharmacotherapy in the treatment of anxiety versus depressive disorders. There seems to be larger differences between the anxiety disorders in terms of their relative responsiveness to pharmacotherapy versus CBT.

摘要

背景

对于抑郁障碍与焦虑障碍，认知行为疗法（CBT）与药物治疗相对而言哪一种更具优势，目前我们知之甚少。

方法

我们进行了一项荟萃分析，其中我们检索了电子数据库和参考文献，以选择比较 CBT 与药物治疗（包括或不包括安慰剂）治疗成人重性抑郁障碍或焦虑障碍的随机对照研究。主要的效应量是根据特定于疾病的结局测量值计算的，即 CBT 与药物治疗结果之间的差异（即，阳性效应量有利于 CBT；阴性效应量有利于药物治疗）。

结果

纳入了 21 项焦虑（N = 1266）和 21 项抑郁（N = 2027）研究，比较了药物治疗与 CBT。包括所有焦虑障碍，总的效应量为 0.25（95%CI：-0.02，0.55，P =.07）。与药物治疗相比，惊恐障碍的 CBT 治疗效果显著更好（0.50，95%CI：0.02，0.98）。强迫症的效应大小相似，但无统计学意义（0.49，95%CI：-0.11，1.09）。药物治疗对社交焦虑障碍有轻微优势（-0.22，95%CI：-0.50，0.06）。抑郁研究的总体效应量为 0.05（95%CI：-0.09，0.19），药物治疗或 CBT 均无优势。将焦虑障碍和抑郁研究合并后，CBT 与药物治疗治疗焦虑和抑郁障碍有效性的相对差异的综合比较表明，CBT 在焦虑方面相对于抑郁具有非显著性优势（B = 0.14，95%CI：-0.14，0.43）。