Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands.
BMJ Open. 2013 Apr 26;3(4). doi: 10.1136/bmjopen-2012-002542. Print 2013.
Although cognitive behaviour therapy (CBT) and pharmacotherapy are equally effective in the acute treatment of adult depression, it is not known how they compare across the longer term. In this meta-analysis, we compared the effects of acute phase CBT without any subsequent treatment with the effects of pharmacotherapy that either were continued or discontinued across 6-18 months of follow-up.
We conducted systematic searches in bibliographical databases to identify relevant studies, and conducted a meta-analysis of studies meeting inclusion criteria.
Mental healthcare.
Patients with depressive disorders.
CBT and pharmacotherapy for depression.
Relapse rates at long-term follow-up.
9 studies with 506 patients were included. The quality was relatively high. Short-term outcomes of CBT and pharmacotherapy were comparable, although drop out from treatment was significantly lower in CBT. Acute phase CBT was compared with pharmacotherapy discontinuation during follow-up in eight studies. Patients who received acute phase CBT were significantly less likely to relapse than patients who were withdrawn from pharmacotherapy (OR=2.61, 95% CI 1.58 to 4.31, p<0.001; numbers-needed-to-be-treated, NNT=5). The acute phase CBT was compared with continued pharmacotherapy at follow-up in five studies. There was no significant difference between acute phase CBT and continued pharmacotherapy, although there was a trend (p<0.1) indicating that patients who received acute phase CBT may be less likely to relapse following acute treatment termination than patients who were continued on pharmacotherapy (OR=1.62, 95% CI 0.97 to 2.72; NNT=10).
We found that CBT has an enduring effect following termination of the acute treatment. We found no significant difference in relapse after the acute phase CBT versus continuation of pharmacotherapy after remission. Given the small number of studies, this finding should be interpreted with caution pending replication.
虽然认知行为疗法（CBT）和药物治疗在成人抑郁症的急性期治疗中同样有效，但尚不清楚它们在长期内的效果如何。在本次荟萃分析中，我们比较了无后续治疗的急性期 CBT 与在 6-18 个月随访期间继续或停止药物治疗的效果。
我们在文献数据库中进行了系统检索以确定相关研究，并对符合纳入标准的研究进行了荟萃分析。
精神保健。
患有抑郁症的患者。
CBT 和药物治疗抑郁症。
长期随访时的复发率。
纳入了 9 项研究共 506 名患者。研究质量相对较高。虽然 CBT 的治疗脱落率显著降低，但 CBT 和药物治疗的短期结局相当。在 8 项研究中，急性期 CBT 与药物治疗的停药进行了比较。接受急性期 CBT 的患者复发的可能性明显低于停止药物治疗的患者（OR=2.61，95%CI 1.58 至 4.31，p<0.001；需要治疗的人数，NNT=5）。在 5 项研究中，急性期 CBT 与随访期间的继续药物治疗进行了比较。急性期 CBT 与继续药物治疗之间没有显著差异，但有一个趋势（p<0.1）表明，与继续药物治疗的患者相比，接受急性期 CBT 的患者在急性治疗结束后复发的可能性可能较低（OR=1.62，95%CI 0.97 至 2.72；NNT=10）。
我们发现 CBT 在急性治疗结束后具有持久的效果。我们发现，在急性期 CBT 后与缓解期继续药物治疗后复发之间没有显著差异。鉴于研究数量较少，在复制之前，应谨慎解释这一发现。
