Lancet:认知行为疗法辅助治疗抵抗性抑郁症有效

　　仅1/3的抑郁症患者对抗抑郁药物产生完全应答，但是对于那些治疗抵抗性患者下一步的最佳治疗方式目前几乎尚无相关循证依据。日前，在线发表于《柳叶刀》（Lancet）杂志的一项研究对比了认知行为治疗(CBT)作为包括药物治疗在内的常规治疗的辅助疗法与单纯常规疗法治疗抵抗性抑郁症的相对疗效。结果证实，CBT作为常规疗法的一种辅助疗法是有效的，有助于缓解这类人群的抑郁症状。 

与抑郁症相关的拓展阅读：

• Science:揭示长期压力导致抑郁症的神经机制
• CMAJ：抑郁症增加老年患者住院风险
• Lancet：CBT 可缓解难治性抑郁症状
• Neurology：癫痫患者罹患抑郁症风险增加
• J AFFECT DISORDERS：常吃西红柿抑郁症减半
更多信息请点击：有关抑郁症更多资讯

Cognitive behavioural therapy as an adjunct to pharmacotherapy for primary care based patients with treatment resistant depression: results of the CoBalT randomised controlled trial

Background

Only a third of patients with depression respond fully to antidepressant medication but little evidence exists regarding the best next-step treatment for those whose symptoms are treatment resistant. The CoBalT trial aimed to examine the effectiveness of cognitive behavioural therapy (CBT) as an adjunct to usual care (including pharmacotherapy) for primary care patients with treatment resistant depression compared with usual care alone.

Methods

This two parallel-group multicentre randomised controlled trial recruited 469 patients aged 18—75 years with treatment resistant depression (on antidepressants for ≥6 weeks, Beck depression inventory [BDI] score ≥14 and international classification of diseases [ICD]-10 criteria for depression) from 73 UK general practices. Participants were randomised, with a computer generated code (stratified by centre and minimised according to baseline BDI score, whether the general practice had a counsellor, previous treatment with antidepressants, and duration of present episode of depression) to one of two groups: usual care or CBT in addition to usual care, and were followed up for 12 months. Because of the nature of the intervention it was not possible to mask participants, general practitioners, CBT therapists, or researchers to the treatment allocation. Analyses were by intention to treat. The primary outcome was response, defined as at least 50% reduction in depressive symptoms (BDI score) at 6 months compared with baseline. This trial is registered, ISRCTN38231611.

Findings

Between Nov 4, 2008, and Sept 30, 2010, we assigned 235 patients to usual care, and 234 to CBT plus usual care. 422 participants (90%) were followed up at 6 months and 396 (84%) at 12 months, finishing on Oct 31, 2011. 95 participants (46%) in the intervention group met criteria for response at 6 months compared with 46 (22%) in the usual care group (odds ratio 3·26, 95% CI 2·10—5·06, p<0·001).

Interpretation

Before this study, no evidence from large-scale randomised controlled trials was available for the effectiveness of augmentation of antidepressant medication with CBT as a next-step for patients whose depression has not responded to pharmacotherapy. Our study has provided robust evidence that CBT as an adjunct to usual care that includes antidepressants is an effective treatment, reducing depressive symptoms in this population.