Milgrom Jeannette, Gemmill Alan W, Ericksen Jennifer, Burrows Graham, Buist Anne, Reece John
Parent-Infant Research Institute, Department of Clinical & Health Psychology, Heidelberg Repatriation Hospital, Heidelberg West, Australia Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
Parent-Infant Research Institute, Department of Clinical & Health Psychology, Heidelberg Repatriation Hospital, Heidelberg West, Australia.
Aust N Z J Psychiatry. 2015 Mar;49(3):236-45. doi: 10.1177/0004867414565474. Epub 2015 Jan 13.
Both antidepressant medications and psychological therapy are common treatments for depression in postpartum women. Antidepressant treatment may have a number of practical disadvantages, including a preference by women to avoid medication while breastfeeding. Consequently, more information about the relative benefits of the two modalities in the perinatal period is helpful. In the treatment of depressive disorders there is some evidence that combination therapies (pharmacological plus psychological treatment) may be more efficacious than either form of mono-therapy in isolation. However, in the treatment of postnatal depression, such evidence is limited.
Forty five postpartum women with a DSM-IV diagnosis of depression were randomised to receive either: 1) cognitive behavioural therapy (CBT); 2) sertraline, or 3) a combination of both treatment modalities. Psychometric measures were collected weekly for 12 weeks, with a follow-up at 24 weeks.
Symptoms of depression and anxiety were reduced to a significant degree following all three treatments. CBT mono-therapy was found to be superior to both sertraline mono-therapy and combination therapy after 12 weeks. The CBT mono-therapy group appeared to display the most rapid initial gains after treatment commencement.
In this sample, a specialised CBT program for postnatal depression was found to be superior as a mono-therapy compared to sertraline, a commonly prescribed SSRI antidepressant. This is in contrast to previous studies which have found no detectable difference in the efficacies of drug and psychological treatment for postnatal depression. Unlike some previous work, this study allowed a statistically independent evaluation of CBT mono-therapy for postnatal depression compared to both antidepressant and combination therapy. In line with previous studies in postpartum women, there was no detectable advantage of combining pharmacological and psychological treatments in the short term.
抗抑郁药物和心理治疗都是产后女性抑郁症的常见治疗方法。抗抑郁治疗可能存在一些实际缺点，包括女性在母乳喂养期间倾向于避免用药。因此，了解这两种治疗方式在围产期的相对益处很有帮助。在抑郁症治疗中，有证据表明联合治疗（药物治疗加心理治疗）可能比单独的任何一种单一疗法更有效。然而，在产后抑郁症治疗方面，此类证据有限。
45名被诊断为DSM-IV抑郁症的产后女性被随机分为三组，分别接受：1）认知行为疗法（CBT）；2）舍曲林，或3）两种治疗方式的联合治疗。在12周内每周收集心理测量指标，并在24周时进行随访。
三种治疗后，抑郁和焦虑症状均有显著减轻。12周后发现CBT单一疗法优于舍曲林单一疗法和联合疗法。CBT单一疗法组在治疗开始后似乎显示出最快的初始疗效。
在这个样本中，发现一种专门针对产后抑郁症的CBT项目作为单一疗法优于常用的SSRI抗抑郁药舍曲林。这与之前的研究形成对比，之前的研究未发现药物治疗和心理治疗对产后抑郁症的疗效有可检测到的差异。与之前的一些研究不同，本研究对CBT单一疗法治疗产后抑郁症与抗抑郁药和联合疗法进行了统计学上独立的评估。与之前对产后女性的研究一致，短期内联合药物治疗和心理治疗没有可检测到的优势。
