Paauw Corine, de Roos Carlijn, Tummers Judith, de Jongh Ad, Dingemans Alexandra
GGZ Rivierduinen Children and Youth, Institute for Mental Health, Leiden, The Netherlands.
De Bascule, Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands.
Eur J Psychotraumatol. 2019 Nov 8;10(1):1682931. doi: 10.1080/20008198.2019.1682931. eCollection 2019.
: Major Depressive Disorder (MDD) in adolescence has a high prevalence and risk of disability, but current treatments show limited effectiveness and high drop-out and relapse rates. Although the role of distressing experiences that relate to the development and maintenance of MDD has been recognized for decades, the efficacy of a trauma-focused treatment approach for MDD has hardly been studied. : To determine the effectiveness of eye movement desensitization and reprocessing (EMDR) therapy as a stand-alone intervention in adolescents diagnosed with MDD. We hypothesized that reprocessing core memories related to the onset and maintenance of MDD using EMDR therapy would be associated with a significant decrease in depressive and comorbid symptoms. : We recruited 32 adolescents (12-18 years) fulfilling DSM-IV criteria for mild to moderate-severe MDD from an outpatient youth mental health care unit. Treatment consisted of six weekly 60-min individual sessions. Presence or absence of MDD classification (ADIS-C), symptoms of depression (CDI), symptoms of posttraumatic stress (UCLA), anxiety (SCARED), somatic complaints (CSI), and overall social-emotional functioning (SDQ) were assessed pre and post-treatment and 3 months after treatment. : 60.9% of the adolescents completing treatment no longer met DSM-IV criteria for MDD after treatment anymore, and 69.8% at follow-up. Multilevel analyses demonstrated significant posttreatment reductions of depressive symptoms (CDI: Cohen's = 0.72), comorbid posttraumatic stress, anxiety and somatic complaints, while overall social-emotional functioning improved. These gains were maintained at 3-month follow-up (Cohen's = 1.11). Severity of posttraumatic stress reactions significantly predicted the posttreatment outcome; however, duration of MDD, number of comorbid disorders, or having a history of emotional abuse, emotional neglect or physical neglect were not predictive for outcome. : This is the first study suggesting that EMDR therapy is associated with a significant reduction of depressive symptoms and comorbid psychiatric problems in adolescents with mild to moderate-severe MDD.
青少年重度抑郁症（MDD）患病率高且致残风险大，但目前的治疗效果有限，脱落率和复发率高。尽管与MDD的发生和维持相关的痛苦经历的作用已被认识数十年，但针对MDD的以创伤为重点的治疗方法的疗效几乎未被研究过。
为了确定眼动脱敏再处理（EMDR）疗法作为对诊断为MDD的青少年的独立干预措施的有效性。我们假设，使用EMDR疗法重新处理与MDD的发作和维持相关的核心记忆将与抑郁和共病症状的显著减轻相关。
我们从一个门诊青少年心理健康护理单位招募了32名符合DSM-IV标准的轻度至中度重度MDD的青少年（12 - 18岁）。治疗包括每周6次、每次60分钟的个体治疗。在治疗前、治疗后以及治疗后3个月评估是否存在MDD分类（ADIS-C）、抑郁症状（CDI）、创伤后应激症状（UCLA）、焦虑（SCARED）、躯体主诉（CSI）以及整体社会情感功能（SDQ）。
完成治疗的青少年中，60.9%在治疗后不再符合DSM-IV的MDD标准，随访时这一比例为69.8%。多水平分析显示，治疗后抑郁症状（CDI：科恩d = 0.72）、共病的创伤后应激、焦虑和躯体主诉显著减轻，而整体社会情感功能得到改善。这些改善在3个月随访时得以维持（科恩d = 1.11）。创伤后应激反应的严重程度显著预测了治疗后的结果；然而，MDD的病程、共病障碍的数量，或有情感虐待、情感忽视或身体忽视史并不能预测结果。
这是第一项表明EMDR疗法与轻度至中度重度MDD青少年的抑郁症状和共病精神问题显著减轻相关的研究。
