Holvast Floor, Massoudi Btissame, Oude Voshaar Richard C, Verhaak Peter F M
University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, the Netherlands.
University of Groningen, University Medical Center Groningen, University Center of Psychiatry, Groningen, The Netherlands.
PLoS One. 2017 Sep 22;12(9):e0184666. doi: 10.1371/journal.pone.0184666. eCollection 2017.
Late-life depression is most often treated in primary care, and it usually coincides with chronic somatic diseases. Given that antidepressants contribute to polypharmacy in these patients, and potentially to interactions with other drugs, non-pharmacological treatments are essential. In this systematic review and meta-analysis, we aimed to present an overview of the non-pharmacological treatments available in primary care for late-life depression.
The databases of PubMed, PsychINFO, and the Cochrane Central Register of Controlled Trials were systematically searched in January 2017 with combinations of MeSH-terms and free text words for "general practice," "older adults," "depression," and "non-pharmacological treatment". All studies with empirical data concerning adults aged 60 years or older were included, and the results were stratified by primary care, and community setting. We narratively reviewed the results and performed a meta-analysis on cognitive behavioral therapy in the primary care setting.
We included 11 studies conducted in primary care, which covered the following five treatment modalities: cognitive behavioral therapy, exercise, problem-solving therapy, behavioral activation, and bright-light therapy. Overall, the meta-analysis showed a small effect for cognitive behavioral therapy, with one study also showing that bright-light therapy was effective. Another 18 studies, which evaluated potential non-pharmacological interventions in the community suitable for implementation, indicated that bibliotherapy, life-review, problem-solving therapy, and cognitive behavioral therapy were effective at short-term follow-up.
We conclude that the effects of several treatments are promising, but need to be replicated before they can be implemented more widely in primary care. Although more treatment modalities were effective in a community setting, more research is needed to investigate whether these treatments are also applicable in primary care.
PROSPERO CRD42016038442.
老年期抑郁症大多在初级保健机构接受治疗，且通常与慢性躯体疾病并存。鉴于抗抑郁药会导致这些患者用药种类增多，并可能与其他药物发生相互作用，非药物治疗至关重要。在本系统评价和荟萃分析中，我们旨在概述初级保健机构中可用于治疗老年期抑郁症的非药物治疗方法。
2017年1月，我们通过将医学主题词（MeSH）与“全科医疗”“老年人”“抑郁症”及“非药物治疗”等自由文本词相结合，对PubMed、PsychINFO以及Cochrane对照试验中心注册库进行了系统检索。纳入所有涉及60岁及以上成年人的实证研究，并按初级保健机构和社区环境对结果进行分层。我们对结果进行了叙述性综述，并对初级保健环境中的认知行为疗法进行了荟萃分析。
我们纳入了11项在初级保健机构开展的研究，这些研究涵盖以下五种治疗方式：认知行为疗法、运动疗法、解决问题疗法、行为激活疗法和强光疗法。总体而言，荟萃分析显示认知行为疗法有较小的疗效，有一项研究还表明强光疗法有效。另外18项评估社区中适合实施的潜在非药物干预措施的研究表明，阅读疗法、生活回顾疗法、解决问题疗法和认知行为疗法在短期随访中有效。
我们得出结论，几种治疗方法的效果令人期待，但在能更广泛地应用于初级保健之前，需要进行重复验证。虽然更多治疗方式在社区环境中有效，但还需要更多研究来探究这些治疗方法是否也适用于初级保健机构。
PROSPERO CRD42016038442
