Department of Clinical Psychology, VU University Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University and VU University Medical Center Amsterdam, The Netherlands; Leuphana University, Lünebrug, Germany.
World Psychiatry. 2014 Feb;13(1):56-67. doi: 10.1002/wps.20089.
We conducted a meta-analysis of randomized trials in which the effects of treatment with antidepressant medication were compared to the effects of combined pharmacotherapy and psychotherapy in adults with a diagnosed depressive or anxiety disorder. A total of 52 studies (with 3,623 patients) met inclusion criteria, 32 on depressive disorders and 21 on anxiety disorders (one on both depressive and anxiety disorders). The overall difference between pharmacotherapy and combined treatment was Hedges' g = 0.43 (95% CI: 0.31-0.56), indicating a moderately large effect and clinically meaningful difference in favor of combined treatment, which corresponds to a number needed to treat (NNT) of 4.20. There was sufficient evidence that combined treatment is superior for major depression, panic disorder, and obsessive-compulsive disorder (OCD). The effects of combined treatment compared with placebo only were about twice as large as those of pharmacotherapy compared with placebo only, underscoring the clinical advantage of combined treatment. The results also suggest that the effects of pharmacotherapy and those of psychotherapy are largely independent from each other, with both contributing about equally to the effects of combined treatment. We conclude that combined treatment appears to be more effective than treatment with antidepressant medication alone in major depression, panic disorder, and OCD. These effects remain strong and significant up to two years after treatment. Monotherapy with psychotropic medication may not constitute optimal care for common mental disorders.
我们对随机试验进行了荟萃分析，比较了抗抑郁药物治疗与联合药物治疗和心理治疗对诊断为抑郁或焦虑障碍的成年人的治疗效果。共有 52 项研究（共 3623 名患者）符合纳入标准，其中 32 项为抑郁症，21 项为焦虑症（1 项为抑郁症和焦虑症）。药物治疗与联合治疗之间的总体差异为 Hedges' g=0.43（95%CI：0.31-0.56），表明联合治疗具有中度大的效果和临床上有意义的优势，这相当于需要治疗的人数（NNT）为 4.20。有充分证据表明联合治疗在重度抑郁症、惊恐障碍和强迫症（OCD）方面优于单独药物治疗。与单独药物治疗相比，联合治疗与安慰剂相比的效果大约是药物治疗与安慰剂相比的效果的两倍，这突显了联合治疗的临床优势。结果还表明，药物治疗和心理治疗的效果在很大程度上是相互独立的，两者对联合治疗的效果贡献大致相同。我们的结论是，联合治疗在重度抑郁症、惊恐障碍和强迫症方面似乎比单独使用抗抑郁药物治疗更有效。这些效果在治疗后两年内仍然强烈且显著。单一使用精神药物治疗可能不是常见精神障碍的最佳治疗方法。
