Driessen Ellen, Dekker Jack J M, Peen Jaap, Van Henricus L, Maina Giuseppe, Rosso Gianluca, Rigardetto Sylvia, Cuniberti Francesco, Vitriol Veronica G, Florenzano Ramon U, Andreoli Antonio, Burnand Yvonne, López-Rodríguez Jaime, Villamil-Salcedo Valerio, Twisk Jos W R, Cuijpers Pim
Department of Clinical Psychology, Behavioural Science Institute, Radboud University, Nijmegen, Netherlands; Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
Department of Research, Arkin Mental Health Care, Amsterdam, Netherlands.
Clin Psychol Rev. 2020 Aug;80:101886. doi: 10.1016/j.cpr.2020.101886. Epub 2020 Jun 26.
We examined the efficacy of adding short-term psychodynamic psychotherapy (STPP) to antidepressants in the treatment of depression by means of a systematic review and meta-analysis of individual participant data, which is currently considered the most reliable method for evidence synthesis.
A thorough systematic literature search resulted in 7 studies comparing combined treatment of antidepressants and STPP versus antidepressant mono-therapy (n = 3) or versus antidepressants and brief supportive psychotherapy (n = 4). Individual participant data were obtained for all these studies and totaled 482 participants. Across the total sample of studies, combined treatment of antidepressants and STPP was found significantly more efficacious in terms of depressive symptom levels at both post-treatment (Cohen's d = 0.26, SE = 0.10, p = .01) and follow-up (d = 0.50, SE = 0.10, p < .001). This effect was most apparent at follow-up and in studies examining STPP's specific treatment efficacy. Effects were still apparent in analyses that controlled for risk of bias and STPP quality in the primary studies.
These findings support the evidence-base of adding STPP to antidepressants in the treatment of depression. However, further studies are needed, particularly assessing outcome measures other than depression and cost-effectiveness, as well as examining the relative merits of STPP versus other psychotherapies as added to antidepressants.
我们通过对个体参与者数据进行系统评价和荟萃分析，检验了在抑郁症治疗中，在抗抑郁药基础上加用短期心理动力心理治疗（STPP）的疗效，目前这种方法被认为是证据合成最可靠的方法。
全面的系统文献检索得到7项研究，比较了抗抑郁药与STPP联合治疗与抗抑郁药单药治疗（n = 3）或与抗抑郁药及简短支持性心理治疗（n = 4）的疗效。获取了所有这些研究的个体参与者数据，总计482名参与者。在整个研究样本中，发现在治疗后（科恩d值 = 0.26，标准误 = 0.10，p = 0.01）和随访时（d值 = 0.50，标准误 = 0.10，p < 0.001），抗抑郁药与STPP联合治疗在抑郁症状水平方面显著更有效。这种效果在随访时以及在检验STPP特定治疗效果的研究中最为明显。在控制了主要研究中的偏倚风险和STPP质量的分析中，效果仍然明显。
这些发现支持在抑郁症治疗中在抗抑郁药基础上加用STPP的循证依据。然而，仍需要进一步的研究，特别是评估除抑郁之外的结局指标和成本效益，以及检验STPP与添加到抗抑郁药中的其他心理治疗方法相比的相对优势。
