Dirmaier J, Steinmann M, Krattenmacher T, Watzke B, Barghaan D, Koch U, Schulz H
University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Martinistraße 52, 20246 Hamburg, Germany.
Rev Recent Clin Trials. 2012 May;7(2):141-9. doi: 10.2174/157488712800100233.
The primary goals of this paper are to describe the collection and evaluation of various nonpharmacological treatment options for depressive disorders and to establish a basis for the development of a standard for the treatment of patients with depressive disorders.
To identify evidence-based treatment elements, a comprehensive investigation of national and international guidelines was conducted. The extracted guidelines were then assessed with regard to aspects of methodological quality and evidence-based treatment elements. In a further step, specific and systematic literature searches for residual treatment elements were conducted. For the corresponding literature search, a hierarchical approach was chosen in which current guidelines were reviewed first and systematic reviews and meta-analyses second. Psychopharmacological treatments were excluded from the analysis because this is covered by specific guidelines.
The treatment elements with an adequate level of evidence were identified as follows: psychotherapeutic interventions, marital/couples/family therapy and counseling, inclusion of family members, psycho-education, exercise, problem solving therapy, guided self-help and behavioral activation treatments. Further evidence-based methods include diagnostic treatment elements, participative decision-making, development of the therapeutic alliance, Cognitive Behavioral Analysis System for Psychotherapy, computerized cognitive behavior therapy, psychopharmacological therapy, combined psychopharmacological and psychotherapeutic therapy, electroconvulsive therapy, phototherapy, sleep deprivation, repetitive trans-cranial magnetic stimulation (rTMS) and acupuncture.
In summary, using a hierarchical approach, it was possible to assign different levels of evidence to the various treatment options for depression.
本文的主要目标是描述抑郁症各种非药物治疗方案的收集与评估，并为制定抑郁症患者治疗标准奠定基础。
为确定循证治疗要素，对国内和国际指南进行了全面调查。然后对提取的指南在方法学质量和循证治疗要素方面进行评估。进一步针对剩余治疗要素进行特定的系统文献检索。对于相应的文献检索，采用分层方法，首先回顾当前指南，其次是系统评价和荟萃分析。分析中排除了心理药物治疗，因为这有特定指南涵盖。
确定了具有充分证据水平的治疗要素如下：心理治疗干预、婚姻/夫妻/家庭治疗与咨询、家庭成员参与、心理教育、运动、问题解决疗法、引导式自助和行为激活治疗。其他循证方法包括诊断治疗要素、参与式决策、治疗联盟的建立、心理治疗认知行为分析系统、计算机化认知行为治疗、心理药物治疗、心理药物与心理治疗联合治疗、电休克治疗、光疗、睡眠剥夺、重复经颅磁刺激（rTMS）和针灸。
总之，采用分层方法，可以为抑郁症的各种治疗方案赋予不同的证据水平。
