Institute of General Practice, Technische Universität München, Orleansstrasse 47, Munich, Germany.
BMC Fam Pract. 2011 Nov 15;12:127. doi: 10.1186/1471-2296-12-127.
Several systematic reviews have summarized the evidence for specific treatments of primary care patients suffering from depression. However, it is not possible to answer the question how the available treatment options compare with each other as review methods differ. We aim to systematically review and compare the available evidence for the effectiveness of pharmacological, psychological, and combined treatments for patients with depressive disorders in primary care.
METHODS/DESIGN: To be included, studies have to be randomized trials comparing antidepressant medication (tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), hypericum extracts, other agents) and/or psychological therapies (e.g. interpersonal psychotherapy, cognitive therapy, behavioural therapy, short dynamically-oriented psychotherapy) with another active therapy, placebo or sham intervention, routine care or no treatment in primary care patients in the acute phase of a depressive episode. Main outcome measure is response after completion of acute phase treatment. Eligible studies will be identified from available systematic reviews, from searches in electronic databases (Medline, Embase and Central), trial registers, and citation tracking. Two reviewers will independently extract study data and assess the risk of bias using the Cochrane Collaboration's corresponding tool. Meta-analyses (random effects model, inverse variance weighting) will be performed for direct comparisons of single interventions and for groups of similar interventions (e.g. SSRIs vs. tricyclics) and defined time-windows (up to 3 months and above). If possible, a global analysis of the relative effectiveness of treatments will be estimated from all available direct and indirect evidence that is present in a network of treatments and comparisons.
Practitioners do not only want to know whether there is evidence that a specific treatment is more effective than placebo, but also how the treatment options compare to each other. Therefore, we believe that a multiple treatment systematic review of primary-care based randomized controlled trials on the most important therapies against depression is timely.
有几项系统评价总结了针对初级保健患者抑郁症的特定治疗方法的证据。然而，由于综述方法不同，无法回答可用治疗选择相互比较的问题。我们旨在系统地评价和比较初级保健中针对抑郁障碍患者的药物治疗、心理治疗和联合治疗的有效性的现有证据。
方法/设计：纳入的研究必须是比较抗抑郁药物（三环类抗抑郁药、选择性 5-羟色胺再摄取抑制剂（SSRIs）、贯叶连翘提取物、其他药物）和/或心理治疗（如人际心理治疗、认知治疗、行为治疗、短程动力取向心理治疗）与另一种活性治疗、安慰剂或假干预、常规护理或初级保健患者在抑郁发作急性期不治疗的随机试验。主要结局测量是急性治疗结束后的反应。将从现有系统评价、电子数据库（Medline、Embase 和 Central）、试验登记处和引文追踪中确定合格研究。两名审查员将独立提取研究数据，并使用 Cochrane 协作组相应工具评估偏倚风险。将对单个干预措施和类似干预措施（如 SSRIs 与三环类抗抑郁药）和定义的时间窗（最多 3 个月和以上）进行直接比较的 meta 分析（随机效应模型，倒数方差加权）。如果可能，将根据存在于治疗和比较网络中的所有直接和间接证据，对治疗的相对有效性进行全局分析。
从业者不仅想知道是否有证据表明特定的治疗方法比安慰剂更有效，还想知道治疗选择相互之间的比较情况。因此，我们认为对初级保健为基础的针对抑郁症的最重要治疗方法的基于随机对照试验的多治疗系统评价是及时的。
