Department of Clinical Psychology, Behavioural Science Institute, Radboud University, Nijmegen, Netherlands.
Depression Expertise Centre, Pro Persona Mental Health Care, Nijmegen, Netherlands.
Psychol Med. 2023 Oct;53(13):6090-6101. doi: 10.1017/S0033291722003270. Epub 2022 Nov 21.
Adding short-term psychodynamic psychotherapy (STPP) to antidepressants increases treatment efficacy, but it is unclear which patients benefit specifically. This study examined efficacy moderators of combined treatment (STPP + antidepressants) antidepressants for adults with depression.
For this systematic review and meta-analysis (PROSPERO registration number: CRD42017056029), we searched PubMed, PsycINFO, Embase.com, and the Cochrane Library from inception to 1 January 2022. We included randomized clinical trials comparing combined treatment (antidepressants + individual outpatient STPP) antidepressants in the acute-phase treatment of depression in adults. Individual participant data were requested and analyzed combinedly using mixed-effects models (adding Cochrane risk of bias items as covariates) and an exploratory machine learning technique. The primary outcome was post-treatment depression symptom level.
Data were obtained for all seven trials identified (100%, = 482, combined: = 238, antidepressants: = 244). Adding STPP to antidepressants was more efficacious for patients with high rather than low baseline depression levels [ = -0.49, 95% confidence interval (CI) -0.61 to -0.37, < 0.0001] and for patients with a depressive episode duration of >2 years rather than <1 year ( = -0.68, 95% CI -1.31 to -0.05, = 0.03) and than 1-2 years ( = -0.86, 95% CI -1.66 to -0.06, = 0.04). Heterogeneity was low. Effects were replicated in analyses controlling for risk of bias.
To our knowledge, this is the first study that examines moderators across trials assessing the addition of STPP to antidepressants. These findings need validation but suggest that depression severity and episode duration are factors to consider when adding STPP to antidepressants and might contribute to personalizing treatment selection for depression.
在抗抑郁药的基础上增加短期心理动力学心理治疗（STPP）可以提高治疗效果，但具体哪些患者受益尚不清楚。本研究旨在探讨联合治疗（STPP+抗抑郁药）对抑郁症成年患者的疗效调节因素。
这是一项系统评价和荟萃分析（PROSPERO 注册号：CRD42017056029），我们检索了 PubMed、PsycINFO、Embase.com 和 Cochrane Library 从建库到 2022 年 1 月 1 日的数据。我们纳入了比较抗抑郁药联合（抗抑郁药+个体门诊 STPP）与抗抑郁药在成人抑郁症急性期治疗的随机临床试验。我们请求并联合使用混合效应模型（将 Cochrane 偏倚风险项目作为协变量）和探索性机器学习技术分析个体参与者数据。主要结局是治疗后抑郁症状水平。
共纳入了 7 项试验（100%，n=482，联合治疗组：n=238，抗抑郁药组：n=244）。与基线抑郁水平较低的患者相比，基线抑郁水平较高的患者接受 STPP 联合抗抑郁药治疗的效果更好[标准化均数差（SMD）=-0.49，95%置信区间（CI）-0.61 至 -0.37，P<0.0001]；与抑郁发作持续时间<1 年的患者相比，发作持续时间>2 年的患者（SMD=-0.68，95%CI-1.31 至 -0.05，P=0.03）和 1-2 年的患者（SMD=-0.86，95%CI-1.66 至 -0.06，P=0.04）接受 STPP 联合抗抑郁药治疗的效果更好。异质性较低。在控制偏倚风险的分析中，结果得到了复制。
据我们所知，这是第一项评估将 STPP 添加到抗抑郁药中对疗效的调节作用的试验研究。这些发现需要进一步验证，但提示抑郁严重程度和发作持续时间是在抗抑郁药基础上添加 STPP 时需要考虑的因素，可能有助于针对抑郁症进行个体化治疗选择。
