Psychiatric Research Unit, Copenhagen University Hospital, Region Zealand, Roskilde, Denmark.
PLoS One. 2011;6(8):e22890. doi: 10.1371/journal.pone.0022890. Epub 2011 Aug 4.
Major depressive disorder afflicts an estimated 17% of individuals during their lifetimes at tremendous suffering and costs. Cognitive therapy may be an effective treatment option for major depressive disorder, but the effects have only had limited assessment in systematic reviews.
METHODS/PRINCIPAL FINDINGS: Cochrane systematic review methodology, with meta-analyses and trial sequential analyses of randomized trials, are comparing the effects of cognitive therapy versus 'treatment as usual' for major depressive disorder. To be included the participants had to be older than 17 years with a primary diagnosis of major depressive disorder. Altogether, we included eight trials randomizing a total of 719 participants. All eight trials had high risk of bias. Four trials reported data on the 17-item Hamilton Rating Scale for Depression and four trials reported data on the Beck Depression Inventory. Meta-analysis on the data from the Hamilton Rating Scale for Depression showed that cognitive therapy compared with 'treatment as usual' significantly reduced depressive symptoms (mean difference -2.15 (95% confidence interval -3.70 to -0.60; P<0.007, no heterogeneity)). However, meta-analysis with both fixed-effect and random-effects model on the data from the Beck Depression Inventory (mean difference with both models -1.57 (95% CL -4.30 to 1.16; P = 0.26, I(2) = 0) could not confirm the Hamilton Rating Scale for Depression results. Furthermore, trial sequential analysis on both the data from Hamilton Rating Scale for Depression and Becks Depression Inventory showed that insufficient data have been obtained.
Cognitive therapy might not be an effective treatment for major depressive disorder compared with 'treatment as usual'. The possible treatment effect measured on the Hamilton Rating Scale for Depression is relatively small. More randomized trials with low risk of bias, increased sample sizes, and broader more clinically relevant outcomes are needed.
重度抑郁症在其一生中估计会影响 17%的个体，给他们带来巨大的痛苦和经济负担。认知疗法可能是重度抑郁症的一种有效治疗选择，但在系统评价中，其效果仅得到了有限的评估。
方法/主要发现：采用 Cochrane 系统评价方法，对随机试验进行荟萃分析和试验序贯分析，比较认知疗法与“常规治疗”对重度抑郁症的疗效。纳入的参与者必须为年龄大于 17 岁，且有重度抑郁症的主要诊断。共有 8 项试验，共计纳入 719 名参与者，均存在高偏倚风险。其中 4 项试验报告了汉密尔顿抑郁量表 17 项（HAMD-17）的结果，4 项试验报告了贝克抑郁量表（BDI）的结果。对 HAMD-17 结果的荟萃分析表明，认知疗法与“常规治疗”相比，显著降低了抑郁症状（平均差值-2.15 [95%置信区间 -3.70 至 -0.60；P<0.007，无异质性]）。然而，对 BDI 结果的固定效应和随机效应模型的荟萃分析均不能证实 HAMD-17 的结果（两种模型的平均差值均为-1.57 [95%置信区间 -4.30 至 1.16；P = 0.26，I(2) = 0]）。此外，对 HAMD-17 和 BDI 结果的试验序贯分析表明，目前获得的数据还不够充分。
与“常规治疗”相比，认知疗法可能不是重度抑郁症的有效治疗方法。在 HAMD-17 上测量的可能的治疗效果相对较小。需要更多低偏倚风险、更大样本量、更广泛和更具临床相关性的结局的随机试验。
