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首页> 外文期刊>The journal of clinical psychiatry >Short-term dynamic psychotherapy versus pharmacotherapy for major depressive disorder: a randomized, placebo-controlled trial.
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Short-term dynamic psychotherapy versus pharmacotherapy for major depressive disorder: a randomized, placebo-controlled trial.

机译：短期动态心理疗法与药物疗法治疗重度抑郁症：一项随机，安慰剂对照的试验。

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OBJECTIVE: To determine whether supportive-expressive psychotherapy (SET), a form of dynamic psychotherapy, and pharmacotherapy + clinical management (MED) for major depressive disorder (MDD) are more effective than pill-placebo + clinical management (PBO). METHOD: This National Institute of Mental Health (NIMH)-sponsored randomized controlled trial was conducted (from November 2001 through June 2007) at the University of Pennsylvania Medical School. The sample included 156 patients diagnosed with MDD (DSM-IV) and having a 17-item Hamilton Rating Scale for Depression (HRSD(17)) score >/= 14 for at least 2 consecutive weeks. This was an underserved sample in which 41% were male, 52% were self-designated minorities, and 76% had an annual income under Dollars 30,000. Treatment lasted 16 weeks. Medication patients not responsive by week 8 (maximum dose 200 mg/d of sertraline) were switched to venlafaxine (maximum dose 375 mg/d). Nonresponsive placebo patients at week 8 were switched to a different placebo. RESULTS: Patients' depression improved over the 16 weeks (P < .0001), with no between-group differences (P = .95), even among severely (HRSD(17) score >/= 20) depressed patients (P = .45). Response rates did not differ between groups (P = .73). Gender and minority status moderated outcome (P = .014), with psychotherapy more efficacious for minority men than MED (P = .027, Cohen d = 1.02) and PBO (P = .019, d = 1.09). PBO was more efficacious for white men than MED (P = .03, d = 0.62) and SET (P = .003, d = 1.07). For white women, MED (P = .005, d = 0.77) and SET (P = .033, d = 0.71) were more efficacious than placebo. No differences among treatments were found for minority women. CONCLUSIONS: This trial of urban MDD patients failed to confirm that either active treatment was better than placebo. Minority status and gender had significant and differential effects on outcome that warrant replication in future studies. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00043550.
机译：目的：确定对于重度抑郁症（MDD）而言，动态心理治疗的一种形式的支持性心理治疗（SET）和药物治疗+临床管理（MED）是否比药物-安慰剂+临床管理（PBO）更有效。方法：这项由美国国家心理健康研究所（NIMH）赞助的随机对照试验（从2001年11月至2007年6月）在宾夕法尼亚大学医学院进行。该样本包括156例被诊断为MDD（DSM-IV）且至少连续2周的17项汉密尔顿抑郁量表（HRSD（17））得分> / = 14的患者。这是一个服务不足的样本，其中41％是男性，52％是自我指定的少数民族，76％的年收入低于30,000美元。治疗持续16周。在第8周无反应的药物治疗患者（最大剂量舍曲林200 mg / d）转为文拉法辛（最大剂量375 mg / d）。将无反应的安慰剂患者在第8周改用其他安慰剂。结果：患者抑郁症在16周内有所改善（P <.0001），组间差异无统计学意义（P = .95），即使严重抑郁症患者（HRSD（17）得分> / = 20）（P =。 45）。两组之间的反应率没有差异（P = 0.73）。性别和少数群体状况可改善结局（P = .014），而心理疗法对少数群体男性的疗效比MED（P = .027，Cohen d = 1.02）和PBO（P = .019，d = 1.09）更有效。与MED（P = .03，d = 0.62）和SET（P = .003，d = 1.07）相比，PBO对白人男性更有效。对于白人女性，MED（P = .005，d = 0.77）和SET（P = .033，d = 0.71）比安慰剂更有效。少数民族妇女的治疗方法无差异。结论：该城市MDD患者试验未能证实任何一种积极治疗均优于安慰剂。少数民族的地位和性别对结果有显着和不同的影响，因此有必要在以后的研究中加以重复。试验注册：clinicaltrials.gov标识符：NCT00043550。

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