Всемирная психиатрия. №2 2019

Симптом-специфическая эффективность антидепрессантов в сравнении с когнитивно-поведенческой терапией в лечении депрессии: результаты метаанализа индивидуальных данных пациентов

Lynn Boschloo1,2, Ella Bekhuis2, Erica S. Weitz1, Mirjam Reijnders1, Robert J. DeRubeis3, Sona Dimidjian4, David L. Dunner5, Boadie W. Dunlop6, Ulrich Hegerl7, Steven D. Hollon8, Robin B. Jarrett9, Sidney H. Kennedy10, Jeanne Miranda11, David C. Mohr12, Anne D. Simons13, Gordon Parker14, Frank Petrak15, Stephan Herpertz15, Lena C. Quilty10,16, A. John Rush17-19, Zindel V. Segal20, Jeffrey R. Vittengl21, Robert A. Schoevers2, Pim Cuijpers1

1Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; 2Department of Psychiatry and Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; 3Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA; 4Department of Psychology and Neuroscience, University of Colorado, Boulder, CO, USA; 5Center for Anxiety and Depression, Mercer Island, Washington, WA, USA; 6Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA; 7Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany; 8Department of Psychology, Vanderbilt University, Nashville, TN, USA; 9Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA; 10Department of Psychiatry, University of Toronto, Toronto, ON, Canada; 11Health Services Research Center, Neuropsychiatric Institute, University of California, Los Angeles, CA, USA; 12Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; 13Department of Psychology, University of Notre Dame, Notre Dame, IN, USA; 14School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; 15Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic (Bochum, Ruhr University Bochum, Bochum, Germany; 16Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; 17Duke-National University of Singapore Graduate Medical School, Singapore; 18Department of Psychiatry, Duke Medical School, Durham, NC, USA; 19Texas Tech University Health Sciences Center, Permian Basin, TX, USA; 20Department of Psychology, University of Toronto Scarborough, Toronto, ON, Canada; 21Department of Psychology,Truman State University, Kirksville, MO, USA)

Стр. 189-197

1362 просмотров

Опубликовано: 15 мая 2019

Аннотация / Abstract

Перевод: Шишорин Р.М. (Москва) Редактура: к.м.н. Рукавишников Г.В. (Санкт-Петербург) Boschloo L, Bekhuis E, Weitz ES et al. The symptom-specific efficacy of antidepressant medication vs. cognitive behavioral therapy in the treatment of depression: results from an individual patient data meta-analysis. World Psychiatry 2019;18(2):183–191. Резюме Недавний метаанализ индивидуальных данных пациентов показал, что антидепрессанты были несколько более эффективны, чем когнитивно-поведенческая терапия (КПТ) в снижении общей тяжести депрессии у пациентов с депрессивным расстройством, установленным по критериям DSM. Мы использовали обновленный массив этих данных на основании семнадцати рандомизированных клинических исследований для более подробной оценки сравнительной эффективности антидепрессантов и КПТ с упором на отдельные депрессивные симптомы по Шкале оценки депрессии Гамильтона (HAMD-17). Пять симптомов («сниженное настроение», «чувство вины», «суицидальные мысли», «психическая тревога» и «соматические симптомы») показали более выраженное улучшение при использовании препаратов в сравнении с КПТ (величина эффекта в диапазоне от 0,13 до 0,16), в то время как для других двенадцати симптомов не было найдено никаких различий. Также сетевая методика оценивания обнаружила, что все эффекты, за исключением связанного со «сниженным настроением», были прямыми и не могли быть объяснены какими-либо другими прямыми или косвенными эффектами лечения. Предварительный анализ показал, что информация о симптом-специфической эффективности могла бы помочь с выявлением тех пациентов, которым на основании оценки их симптомов до начала лечения с большей вероятностью поможет терапия антидепрессантами, чем КПТ (величина эффекта 0,30), в сравнении с теми, у которых оба лечения будут иметь равную эффективность. В целом наш симптомориентированный подход ведет к более тщательной оценке эффективности антидепрессантов в сравнении с КПТ и демонстрирует возможности «персонализирован...

Материал для специалистов

Полный текст статьи доступен только зарегистрированным пользователям.

Вход / Регистрация

1. Mulrow CD, Williams JWJr, Chiquette E et al. Efficacy of newer medications for treating depression in primary care patients. Am J Med 2000;108:54-64.
2. Churchill R, Hunot V, Corney R et al. A systematic review of controlled trials of the effectiveness and cost-effectiveness of brief psychological treatments for depression. Health Technol Assess 2001;5:1-173.
3. Butler AC, Chapman JE, Forman EM et al. The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clin Psychol Rev 2006;26:17-31.
4. Cuijpers P, Berking M, Andersson G et al. A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. Can J Psychiatry 2013;58:376-85.
5. Weitz ES, Hollon SD, Twisk J et al. Baseline depression severity as a moderator of depression outcomes between cognitive behavioral therapy versus pharmacotherapy. An individual patient data meta-analysis. JAMA Psychiatry 2015;72:1102-9.
6. Riley RD, Lambert PC, Abo-Zaid G. Meta-analysis of individual participant data: rationale, conduct, and reporting. BMJ 2010;340:c221.
7. Stewart JG, Harkness KL. Symptom specificity in the acute treatment of Major Depressive Disorder: a re-analysis of the treatment of Depression Collaborative Research Program. J Affect Disord 2012;137:87-97.
8. Dunlop BW, Cole SP, Nemeroff CB et al. Differential change on depressive symptom factors with antidepressant medication and cognitive behavior therapy for major depressive disorder. J Affect Disord 2018;229:111-9.
9. Fournier JC, De Rubeis RJ, Hollon SD et al. Differential change in specific depressive symptoms during antidepressant medication or cognitive therapy. Behav Res Ther 2013;51:392-8.
10. Fried EI, Van Borkulo CD, Epskamp S et al. Measuring depression over time ... or not? Lack of unidimensionality and longitudinal measurement invariance in four common rating scales of depression. Psychol Assess 2016;28:1354-67.
11. Fried EI, Boschloo L, Van Borkulo CD et al. Consistent superiority of selective serotonin reuptake inhibitors over placebo in reducing depressed mood in patients with major depression. Front Psychiatry 2015;6:117.
12. Hieronymus F, Emilsson JF, Nilsson S et al. Consistent superiority of selective serotonin reuptake inhibitors over placebo in reducing depressed mood in patients with major depression. Mol Psychiatry 2016;21:523-30.
13. Bekhuis E, Schoevers RA, De Boer MK et al. Symptom-specific effects of psychotherapy versus combined therapy in the treatment of mild to moderate depression: a network approach. Psychother Psychosom 2018; 87:121-3.
14. Mohr DC, Boudewyn AC, Goodkin DE et al. Comparative outcomes for individual cognitive-behavior therapy, supportive-expressive group psychotherapy, and sertraline for the treatment of depression in multiple sclerosis. J Consult Clin Psychol 2001;69:942-9.
15. Hegerl U, Hautzinger M, Mergl R et al. Effects of pharmacotherapy and psychotherapy in depressed primary-care patients: a randomized, controlled trial including a patients’ choice arm. Int J Neuropsychopharmacol 2010;13:31-44.
16. Jarrett RB, Schaffer M, McIntire D et al. Treatment of atypical depression with cognitive therapy or phenelzine: a double-blind, placebo-controlled trial. Arch Gen Psychiatry 1999;56:431-7.
17. DeRubeis RJ, Hollon SD, Amsterdam JD et al. Cognitive therapy vs medications in the treatment of moderate to severe depression. Arch Gen Psychiatry 2005;62:409-16.
18. Elkin I, Shea MT, Watkins JT et al. National Institute of Mental Health Treatment of Depression Collaborative Research Program: general effectiveness of treatments. Arch Gen Psychiatry 1989;46:971-82.
19. Rush AJ, Beck AT, Kovacs M et al. Comparative efficacy of cognitive therapy and pharmacotherapy in the treatment of depressed outpatients. Cogn Ther Res 1977;1:17-37.
20. Miranda J, Chung JY, Green BL et al. Treating depression in predominantly low-income young minority women: a randomized controlled trial. JAMA 2003;290:57-65.
21. Hollon SD, DeRubeis RJ, Evans MD et al. Cognitive therapy and pharmacotherapy for depression: singly and in combination. Arch Gen Psychiatry 1992;49:774-81.
22. Kennedy SH, Konarski JZ, Segal ZV et al. Differences in brain glucose metabolism between responders to CBT and venlafaxine in a 16-week randomized controlled trial. Am J Psychiatry 2007;164:778-88.
23. Dunlop BW, Kelley ME, Mletzko TC et al. Depression beliefs, treatment preference, and outcomes in a randomized trial for major depressive disorder. J Psychiatr Res 2012;46:375-81.
24. Segal ZV, Kennedy S, Gemar M et al. Cognitive reactivity to sad mood provocation and the prediction of depressive relapse. Arch Gen Psychiatry 2006;63:749-55.
25. Murphy GE, Simons AD, Wetzel RD et al. Cognitive therapy and pharmacotherapy: singly and together in the treatment of depression. Arch Gen Psychiatry 1984;41:33-41.
26. Dunner DL, Schmaling KB, Hendrickson H et al. Cognitive therapy versus fluoxetine in the treatment of dysthymic disorder. Depression 1996;4:34-41.
27. Dimidjian S, Hollon SD, Dobson KS et al. Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. J Consult Clin Psychol 2006;74:658-70.
28. Parker G, Blanch B, Paterson A et al. The superiority of antidepressant medication to cognitive behavior therapy in melancholic depressed patients: a 12-week single-blind randomized study. Acta Psychiatr Scand 2013;128:271-81.
29. Petrak F, Herpertz S, Albus C et al. Study Protocol of the Diabetes and Depression Study (DAD): a multi-center randomized trial to compare the efficacy of a diabetes-specific cognitive behavioral group therapy versus sertraline in patients with major depression and poorly controlled diabetes mellitus. BMC Psychiatry 2013;13:206.
30. Quilty LC, Dozois DJ, Lobo DS et al. Cognitive structure and processing during cognitive behavioral therapy vs. pharmacotherapy for depression. Int JCogn Ther 2014:7:235-50.
31. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56-62.
32. Haslbeck JMB, Waldorp LJ. mgm: estimating time-varying mixed graphical models in high-dimensional data. Submitted for publication.
33. Friedman J, Hastie T, Tibshirani R. Regularization paths for generalized linear models via coordinate descent. J Stat Softw 2010;33:
1-22.
34. Meinshausen N, Buhlmann P. High-dimensional graphs and variable selection with the Lasso. Ann Statist 2006;34:1436-62.
35. Epskamp S, Cramer AOJ, Waldorp LJ et al. qgraph: network visualizations of relationships in psychometric data. J Stat Softw 2012;48:1-18.
36. Van Borkulo CD. Network comparison test: permutation-based test of differences in strength of networks. https://github.com/cvborkulo/Network-ComparisonTest.
37. Snippe E, Viechtbauer W, Geschwind N et al. The impact of treatments for depression on the dynamic network structure of mental states: two randomized controlled trials. Sci Rep 2017;7:46523.
38. Bekhuis E, Schoevers RA, van Borkulo CD. The network structure of major depressive disorder, generalized anxiety disorder and somatic symptomatology. Psychol Med 2016;46:2989-98.
39. Boschloo L, Van Borkulo CD, Borsboom D et al. A prospective study on how symptoms in a network predict the onset of depression. Psychother Psychosom 2016;85:183-4.
40. Boschloo L, Van Borkulo CD, Rhemtula M et al. The network structure of symptoms of the Diagnostic and Statistical Manual of Mental Disorders. PLoS One 2015;10:e0137621.
41. Kendler KS, Aggen SH, Flint J et al. The centrality of DSM and non-DSM depressive symptoms in Han Chinese women with major depression. J Affect Disord 2018;227:739-44.
42. Cicchetti DV, Prusoff BA. Reliability of depression and associated clinical symptoms. Arch Gen Psychiatry 1983;40:987-90.
43. Morriss R, Leese M, Chatwin J et al. Inter-rater reliability of the Hamilton Depression Rating Scale as a diagnostic and outcome measure of depression in primary care. J Affect Disord 2008;111:204-13.
44. Entsuah R, Schaffer M, Zhang J. A critical examination of the sensitivity of unidimensional subscales derived from the Hamilton Depression Rating Scale to antidepressant drug effects. J Psychiatr Res 2002;36:437-48.

ЖУРНАЛЫ

ИНТЕРАКТИВ

СПЕЦИАЛИЗАЦИИ

ИЗДАНИЯ-ПАРТНЕРЫ

Материал для специалистов

ЖУРНАЛЫ

ИНТЕРАКТИВ

СПЕЦИАЛИЗАЦИИ

ИЗДАНИЯ-ПАРТНЕРЫ

Материал для специалистов

Con-Med Passport