Centre for Research in Human Development, Department of Psychology, Concordia University, Montréal, Canada.
The Douglas Research Centre, Department of Psychiatry, McGill University, Montréal, Canada.
Psychol Med. 2024 Jul;54(9):2122-2132. doi: 10.1017/S0033291724000217. Epub 2024 Mar 6.
Although both pharmacotherapy and psychological treatments are considered to be efficacious in the treatment of major depressive disorder (MDD), one third of patients do not respond to treatment and many experience residual symptoms post-treatment. In this double-blind placebo-controlled randomized control trial (RCT), we assessed whether intranasal oxytocin (OT) augments the therapeutic efficacy of psychotherapy for MDD and improves the therapeutic alliance.
Twenty-three volunteers (12 female) with MDD underwent 16 sessions of interpersonal therapy. Prior to each session, volunteers self-administered 24 International Units of intranasal OT ( = 12; ) or placebo ( = 11). Depressive symptoms were assessed with the at pre- and post-treatment, and at a six month follow-up.
Multilevel modeling found a significant effect of OT on the negative slope of depressive symptoms over time ( < 0.05), with medium-large effect sizes at post-treatment (Cohen's = 0.75) and follow-up (Cohen's = 0.82). Drug intervention also predicted the intercept when examining the weekly ratings of the therapeutic alliance ( < 0.05), such that volunteers receiving OT, relative to placebo, reported improved therapeutic alliance at session 1. The agreement of goals between therapists and participants, a facet of the therapeutic alliance, mediated the relationship between drug intervention and clinical outcome.
In this pilot study, the administration of intranasal OT, relative to placebo, improved the therapeutic alliance at the beginning of therapy and therapeutic efficacy of psychotherapy in persons with MDD. Future RCTs should attempt to replicate these findings in larger samples with different therapeutic modalities ().
尽管药物治疗和心理治疗被认为对治疗重度抑郁症（MDD）都有效，但仍有三分之一的患者对治疗无反应，许多患者在治疗后仍存在残留症状。在这项双盲安慰剂对照随机对照试验（RCT）中，我们评估了鼻内催产素（OT）是否增强了 MDD 的心理治疗疗效，并改善了治疗联盟。
23 名患有 MDD 的志愿者（12 名女性）接受了 16 次人际治疗。在每次治疗前，志愿者自行使用 24 国际单位的鼻内 OT（ = 12； ）或安慰剂（ = 11）。在治疗前、治疗后和 6 个月随访时，使用 评估抑郁症状。
多层次建模发现 OT 对抑郁症状随时间的负斜率有显著影响（ < 0.05），在治疗后和随访时具有中到大的效应量（Cohen's = 0.75 和 Cohen's = 0.82）。当检查治疗联盟的每周评分时，药物干预也预测了截距（ < 0.05），即与安慰剂相比，接受 OT 的志愿者在第 1 次治疗时报告了治疗联盟的改善。治疗师和参与者之间的目标一致性，即治疗联盟的一个方面，中介了药物干预和临床结果之间的关系。
在这项初步研究中，与安慰剂相比，鼻内 OT 的给药改善了治疗开始时的治疗联盟，并提高了 MDD 患者的心理治疗疗效。未来的 RCT 应尝试在使用不同治疗模式的更大样本中复制这些发现（）。
