Liu Wenliang, Li Gongying, Wang Congjie, Yu Mingchao, Zhu MengYa, Yang Lin
Department of Psychological, Huai'an No.3 People's Hospital, Huaian, People's Republic of China.
Neuropsychiatr Dis Treat. 2022 Nov 2;18:2543-2557. doi: 10.2147/NDT.S367931. eCollection 2022.
The efficacy of medication and psychotherapy for adolescent depression is controversial, so we conducted a meta-analysis to evaluate the efficacy of combination therapy.
We followed the PRISMA checklist in completing the meta-analysis. Relevant literature was searched in PubMed, Web of Science and Embase, Chinese databases CNKI and WanFang Data. We included the literature on the comparison of the fluoxetine plus psychotherapy or cognitive-behavioral therapy (CBT) and each treatment alone for adolescent depression published in 1980-2021. All statistical analyses were performed using Stata software.
After careful review, a total of 489 relevant articles were retrieved, and 13 studies were finally included. In comparison with the control group (fluoxetine alone), fluoxetine plus CBT achieved higher response rate (RR=1.12, 95% CI: 1.04, 1.21), lower incidence of adverse Reactions (RR=0.62,95% CI:0.40,0.96), lower proportion of suicide or self-injury (RR=0.94,95% CI:0.74,1.20), and lower one-year recurrence rate (RR=0.27, 95% CI: 0.16, 0.45). Before treatment, there were no significant differences in Hamilton Depression Scale score (HAMD), Children's Depression Rating Scale Revised (CDRS-R) score, and Clinical Global Impression (CGI) Severity score. After treatment, HAMD score (SMD=-1.01, 95% CI:-1.39,-0.63), CDRS-R score (SMD= -0.10,95% CI:-0.26,-0.07), and CGI score (SMD = -0.22, 95% CI: -0.54, -0.10) were significantly lower in the combined treatment group than in the control group.
Adolescents simultaneously treated with fluoxetine and CBT had significantly reduced incidence of depressive symptoms, suicide or NSSI, adverse reactions, and one-year recurrence of symptoms, than adolescents treated with fluoxetine alone. This indicates fluoxetine plus CBT may be superior to fluoxetine alone for the clinical treatment of adolescent depression.
药物治疗和心理治疗对青少年抑郁症的疗效存在争议，因此我们进行了一项荟萃分析以评估联合治疗的疗效。
我们遵循PRISMA清单完成荟萃分析。在PubMed、科学网和Embase、中国数据库知网和万方数据中检索相关文献。我们纳入了1980 - 2021年发表的关于氟西汀联合心理治疗或认知行为疗法（CBT）与单独使用每种治疗方法治疗青少年抑郁症的比较文献。所有统计分析均使用Stata软件进行。
经过仔细筛选，共检索到489篇相关文章，最终纳入13项研究。与对照组（单独使用氟西汀）相比，氟西汀联合CBT的缓解率更高（RR = 1.12，95%CI：1.04，1.21），不良反应发生率更低（RR = 0.62，95%CI：0.40，0.96），自杀或自我伤害比例更低（RR = 0.94，95%CI：0.74，1.20），一年复发率更低（RR = 0.27，95%CI：0.16，0.45）。治疗前，汉密尔顿抑郁量表评分（HAMD）、儿童抑郁评定量表修订版（CDRS - R）评分和临床总体印象（CGI）严重程度评分无显著差异。治疗后，联合治疗组的HAMD评分（SMD = -1.01，95%CI：-1.39，-0.63）、CDRS - R评分（SMD = -0.10，95%CI：-0.26，-0.07）和CGI评分（SMD = -0.22，95%CI：-0.54，-0.10）均显著低于对照组。
与单独使用氟西汀治疗的青少年相比，同时接受氟西汀和CBT治疗的青少年抑郁症状、自杀或非自杀性自伤的发生率、不良反应以及症状的一年复发率均显著降低。这表明氟西汀联合CBT在青少年抑郁症的临床治疗中可能优于单独使用氟西汀。
