心理治疗、抗抑郁药及其联合治疗慢性重度抑郁症的系统评价。
Psychotherapy, antidepressants, and their combination for chronic major depressive disorder: a systematic review.
机构信息
Program for Mood Disorders Pro Persona, Mental Health Care, Nijmegen, the Netherlands.
出版信息
Can J Psychiatry. 2013 Jul;58(7):386-92. doi: 10.1177/070674371305800703.
OBJECTIVE
Recommendations for treatment of chronic major depressive disorder (cMDD) are mostly based on clinical experiences and on the literature on treatment-resistant depression (TRD) but not on a systematic review of the literature.
METHOD
We conducted a systematic review of 10 randomized controlled trials (RCTs), with 17 comparisons between antidepressants (ADs), psychotherapy, or the combination of both interventions.
RESULTS
The best evidence is for the combination of psychotherapy and ADs, and especially for the combination of the cognitive behavourial analysis system of psychotherapy and ADs. Evidence is very weak for both ADs alone and psychotherapy alone. Assessment of TRD was mostly absent in the studies.
CONCLUSION
The best treatment for cMDD is a combination of psychotherapy and ADs. However, there is a lack of well-performed RCTs in both ADs and psychotherapy and their combination for cMDD. Therefore, the conclusions are preliminary.
目的
慢性重度抑郁症（cMDD）的治疗建议主要基于临床经验和抗抑郁治疗抵抗（TRD）文献，而不是对文献的系统回顾。
方法
我们对 10 项随机对照试验（RCT）进行了系统回顾，其中有 17 项比较了抗抑郁药（AD）、心理治疗或两者联合干预的效果。
结果
最有力的证据是心理治疗与 AD 的联合应用，特别是认知行为分析系统心理治疗与 AD 的联合应用。AD 单药和心理治疗单药的证据都非常薄弱。研究中大多没有评估 TRD。
结论
cMDD 的最佳治疗方法是心理治疗与 AD 的联合应用。然而，针对 cMDD 的 AD 治疗和心理治疗及其联合应用，缺乏执行良好的 RCT。因此，这些结论是初步的。
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