Cognitive therapy is as good as drugs for depression
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《英国医生杂志》
Cognitive therapy is as effective as treatment with antidepressants in moderate to severe depression, a randomised placebo controlled US trial has shown (Archives of General Psychiatry 2005;62:409-16). A follow-up study in the same issue of the journal shows that patients who had completed their course of cognitive therapy were less likely to relapse after treatment had ended than those who completed their course of antidepressants (2005;62:417-22). The findings contradict the American Psychiatric Association抯 guidelines, which say that most moderately and severely depressed patients will medication.
Patients who entered the study had a score of 20 or higher on the modified Hamilton depression rating scale, a questionnaire widely used to measure depression. At 16 weeks, the recovery rate, defined as a score of 12 or less on the rating scale, in both the antidepressant and cognitive therapy groups was the same, 58%.
In the follow-up study, patients who had responded to antidepressants were randomly assigned to continuation of antidepressants or to placebo for a further year. They were then withdrawn from medication and followed for one year. Patients who had responded to cognitive therapy were allowed up to three more sessions during the year抯 continuation phase, then withdrawn from cognitive therapy, and followed for one year. Patients who were withdrawn from cognitive therapy were significantly less likely to relapse than patients whose medications were stopped (31% v 76%, P=0.004).
The lead author of the first study, Robert DeRubeis, professor and chair of the department of psychology at the University of Pennsylvania in Philadelphia, explained that cognitive therapy helps patients learn when they are misinterpreting external evidence and gives them tools to change the incorrect way in which they see things. "Patients learn how to do this on their own, and this is one of the reasons we believe that patients receiving cognitive therapy are protected from relapse," he told the BMJ.
The trial was carried out at two locations, the University of Pennsylvania and Vanderbilt University in Nashville, Tennessee. "We wanted to see if the results were generalisable," Dr DeRubeis told the BMJ.
The researchers evaluated patients using the structured clinical interview from the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) and the Hamilton scale, a questionnaire that asks patients about depressed mood, guilt, suicidal thoughts, sleep problems, anxiety, appetite, libido, and weight gain or loss.
The 240 patients who met the entry criteria were randomly assigned to one of three treatments: antidepressants (120 patients), placebo (60), or cognitive therapy (60). The antidepressant group was larger because patients who responded well to treatment at 16 weeks were to be randomised a second time to a companion study of relapse prevention: a continuation of antidepressant treatment or a transfer to placebo.
Patients received 10-20 mg of the antidepressant paroxetine a day, raised to a maximum of 50 mg for 16 weeks (and in some cases supplemented with lithium or imipramine), or cognitive therapy for 16 weeks. These doses may be higher than used by community doctors, Dr DeRubeis said. Patients receiving cognitive therapy had weekly treatments for the first four weeks, then treatment every other week.
The authors concluded, "Cognitive therapy has an enduring effect that extends beyond the end of treatment. It seems to be as effective as keeping patients on medication."(Janice Hopkins Tanne)
Patients who entered the study had a score of 20 or higher on the modified Hamilton depression rating scale, a questionnaire widely used to measure depression. At 16 weeks, the recovery rate, defined as a score of 12 or less on the rating scale, in both the antidepressant and cognitive therapy groups was the same, 58%.
In the follow-up study, patients who had responded to antidepressants were randomly assigned to continuation of antidepressants or to placebo for a further year. They were then withdrawn from medication and followed for one year. Patients who had responded to cognitive therapy were allowed up to three more sessions during the year抯 continuation phase, then withdrawn from cognitive therapy, and followed for one year. Patients who were withdrawn from cognitive therapy were significantly less likely to relapse than patients whose medications were stopped (31% v 76%, P=0.004).
The lead author of the first study, Robert DeRubeis, professor and chair of the department of psychology at the University of Pennsylvania in Philadelphia, explained that cognitive therapy helps patients learn when they are misinterpreting external evidence and gives them tools to change the incorrect way in which they see things. "Patients learn how to do this on their own, and this is one of the reasons we believe that patients receiving cognitive therapy are protected from relapse," he told the BMJ.
The trial was carried out at two locations, the University of Pennsylvania and Vanderbilt University in Nashville, Tennessee. "We wanted to see if the results were generalisable," Dr DeRubeis told the BMJ.
The researchers evaluated patients using the structured clinical interview from the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) and the Hamilton scale, a questionnaire that asks patients about depressed mood, guilt, suicidal thoughts, sleep problems, anxiety, appetite, libido, and weight gain or loss.
The 240 patients who met the entry criteria were randomly assigned to one of three treatments: antidepressants (120 patients), placebo (60), or cognitive therapy (60). The antidepressant group was larger because patients who responded well to treatment at 16 weeks were to be randomised a second time to a companion study of relapse prevention: a continuation of antidepressant treatment or a transfer to placebo.
Patients received 10-20 mg of the antidepressant paroxetine a day, raised to a maximum of 50 mg for 16 weeks (and in some cases supplemented with lithium or imipramine), or cognitive therapy for 16 weeks. These doses may be higher than used by community doctors, Dr DeRubeis said. Patients receiving cognitive therapy had weekly treatments for the first four weeks, then treatment every other week.
The authors concluded, "Cognitive therapy has an enduring effect that extends beyond the end of treatment. It seems to be as effective as keeping patients on medication."(Janice Hopkins Tanne)