Center for Mental Health Marienheide, Leppestr. 65-67, 51709, Marienheide, Germany.
Psychopharmacology (Berl). 2023 Sep;240(9):1963-1971. doi: 10.1007/s00213-023-06417-4. Epub 2023 Aug 1.
Antidepressants (AD) are mostly considered indispensable for the treatment of major depression. The vast majority of depressive inpatients are treated with AD. However, there is a growing body of studies indicating that the effectiveness of AD is greatly overestimated due to methodological issues with the AD efficacy studies (e.g., publication bias, unintentional unblinding, confusion between withdrawal symptoms and relapse).
The benefit of the additional use of AD in the inpatient treatment of depression with intensive cognitive-behavioral therapy (CBT) has been investigated in a naturalistic design.
Depressiveness was assessed using the Beck Depression Inventory (BDI-II) during a preliminary interview (T0), at admission (T1), at discharge (T2), and at a 6-month follow-up (T3). Two study phases were compared: During Phase A, AD were recommended in accordance with the German guideline. In Phase B, AD were no longer recommended, and they were only prescribed upon explicit request from patients. In phase A (N = 574), 60.3% of all patients were taking AD at discharge. In Phase B (N = 424), 27.9% of patients were on AD at discharge. Apart from the difference in AD usage, the two treatment conditions were similar, and the samples did not significantly differ in terms of age, sex, diagnoses, history of suicide attempts, comorbid anxiety disorders, and unemployment.
In both study phases, BDI-II scores were strongly decreased at T2 and T3, respectively, compared with T1. The BDI-II scores of the two phases did not differ at any of the measurement time points. Depression changes were similar in both phases. In sequential multiple regression analyses with the total sample, AD were no significant predictors for the reduction of depression at either T2 or T3.
The inpatient CBT was effective in depression. The effectiveness of CBT is not improved by the additional use of AD. The current prescribing practices of AD should be questioned.
抗抑郁药（AD）被认为是治疗重度抑郁症不可或缺的药物。绝大多数住院抑郁症患者都接受 AD 治疗。然而，越来越多的研究表明，由于 AD 疗效研究中存在方法学问题（例如，发表偏倚、非故意的未设盲、撤药症状与复发的混淆），AD 的疗效被大大高估了。
以自然设计的方式，调查在强化认知行为疗法（CBT）住院治疗抑郁症中，额外使用 AD 的益处。
使用贝克抑郁量表（BDI-II）在初步访谈（T0）、入院时（T1）、出院时（T2）和 6 个月随访时（T3）评估抑郁程度。比较了两个研究阶段：在阶段 A 中，根据德国指南推荐使用 AD。在阶段 B 中，不再推荐使用 AD，仅在患者明确要求的情况下开具处方。在阶段 A（N=574）中，出院时所有患者中有 60.3%服用 AD。在阶段 B（N=424）中，出院时 27.9%的患者服用 AD。除了 AD 使用的差异外，两种治疗条件相似，且两个样本在年龄、性别、诊断、自杀企图史、共病焦虑障碍和失业方面无显著差异。
在两个研究阶段中，与 T1 相比，T2 和 T3 的 BDI-II 评分分别显著降低。在任何测量时间点，两个阶段的 BDI-II 评分均无差异。两个阶段的抑郁变化相似。在总样本的序贯多元回归分析中，AD 不是 T2 或 T3 时降低抑郁的显著预测因素。
住院 CBT 对抑郁症有效。CBT 的疗效不能通过额外使用 AD 来提高。目前 AD 的处方实践应受到质疑。
