Raymond W. Lam, MD, Department of Psychiatry, University of British Columbia, UBC Hospital, Vancouver, British Columbia; Sagar V. Parikh, MD, Department of Psychiatry, University of Toronto, University Health Network, Toronto, Ontario; Rajamannar Ramasubbu, MD, Department of Psychiatry, University of Calgary, Calgary, Alberta; Erin E. Michalak, PhD, Edwin M. Tam, MD, Auby Axler, MD, Lakshmi N. Yatham, MBBS, Department of Psychiatry, University of British Columbia, UBC Hospital, Vancouver, British Columbia; Sidney H. Kennedy, MD, Department of Psychiatry, University of Toronto, University Health Network, Toronto, Ontario; Chinnapalli V. Manjunath, MD, Department of Psychiatry, University of British Columbia, Surrey Memorial Hospital, Surrey, British Columbia, Canada.
Br J Psychiatry. 2013 Nov;203(5):358-65. doi: 10.1192/bjp.bp.112.125237. Epub 2013 Sep 12.
Major depressive disorder is associated with significant impairment in occupational functioning and reduced productivity, which represents a large part of the overall burden of depression.
To examine symptom-based and work functioning outcomes with combined pharmacotherapy and psychotherapy treatment of major depressive disorder.
Employed patients with a DSM-IV diagnosis of major depressive disorder were treated with escitalopram 10-20 mg/day and randomised to: (a) telephone-administered cognitive-behavioural therapy (telephone CBT) (n = 48); or (b) adherence-reminder telephone calls (n = 51). Outcomes included the Montgomery-Åsberg Depression Rating Scale (MADRS), administered by masked evaluators via telephone, and self-rated work functioning scales completed online. (Registered at clinicaltrials.gov: NCT00702598.)
After 12 weeks, there were no significant between-group differences in change in MADRS score or in response/remission rates. However, participants in the telephone-CBT group had significantly greater improvement on some measures of work functioning than the escitalopram-alone group.
Combined treatment with escitalopram and telephone-administered CBT significantly improved some self-reported work functioning outcomes, but not symptom-based outcomes, compared with escitalopram alone.
重度抑郁症与职业功能严重受损和生产力降低有关，这是抑郁症总负担的很大一部分。
研究重度抑郁症的联合药物治疗和心理治疗对症状和工作功能的影响。
采用 DSM-IV 重度抑郁症诊断标准的在职患者，每天接受 10-20 毫克依地普仑治疗，并随机分为：（a）电话认知行为疗法（电话 CBT）（n=48）；或（b）电话提醒服药依从性（n=51）。结局包括由盲法评估者通过电话进行的蒙哥马利-Åsberg 抑郁评定量表（MADRS）评估和在线完成的自我评估工作功能量表。（在 clinicaltrials.gov 注册：NCT00702598。）
12 周后，MADRS 评分的变化或反应/缓解率在两组间无显著差异。然而，与依地普仑单药组相比，接受电话 CBT 联合治疗的患者在某些工作功能测量上的改善更为显著。
与依地普仑单药治疗相比，依地普仑联合电话认知行为疗法治疗可显著改善一些自我报告的工作功能结局，但对症状无明显改善。
