舍曲林联合认知行为疗法治疗青少年抑郁症的对照研究

Comparative study on sertraline combined with cognitive behavior therapy in adolescent major depressive disorder

目的探讨舍曲林联合认知行为疗法治疗青少年抑郁症的疗效和安全性。方法将130例符合《中国精神疾病分类方案与诊断标准》第3版(CCMD-3)抑郁症诊断标准的青少年患者随机分为2组(各65例):治疗组应用舍曲林联合认知行为疗法(舍曲林50～200 mg·d^(-1),认知行为疗法每周一次),对照组单一服用舍曲林(50～200 mg·d^(-1))治疗。疗程8 wk。以汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)和症状自评量表(SCL-90)于治疗前和治疗2、4、6、8 wk末分别评定疗效。结果治疗组和对照组分别脱落4例和6例,实际共完成120例。与治疗前相比,2组治疗、wk 2末HAMD、HAMA评分均有显著下降(P<0.05,P<0.01),SCL-90评分无显著变化(P>0.05);2组HAMD、HAMA和SCL-90评分于wk 4、6、8末均显著下降(P<0.01)。2组间相比,wk 4、6、8末HAMD、HAMA和SCL-90评分均有非常显著差异(P<0.01)。2组不良反应主要为恶心、厌食、头晕,组间不良反应发生率无显著差异(x^2=0.512,P=0.474)。结论舍曲林联合认知行为疗法治疗青少年抑郁症较舍曲林单一治疗疗效更佳,安全性相当。

AIM To study the efficacy and safety of sertraline combined with cognitive behavior therapy in adolescents with major depression. METHODS Total 130 adolescents who met diagnostic criteria for major depression in CCMD-3 were randomly divided into two groups （n = 65 for each） ： treatment group used sertraline （50-200 mg. d-1） combined with cognitive behavioral therapy （once a week）, control group used only sertraline （50-200 mg.d-1）. In the 8-week treatment, the efficacy was assessed with Hanmilton Depressive Scale （HAMD）, Hamilton Anxiety Scale （HAMA） and Symptoms Checklist 90 （SCL-90） before and after 2, 4, 6 and 8 wk treatment. RESULTS There were 4 and 6 cases fallen off from the treatment group and control group respectively, with completion of 120 cases. Compared with before the treatment, the scores of HAMD and HAMA in the two groups significantly decreased at the end of wk 2 （P 〈 0.05, P 〈 0.01）, while SCL-90 scores had no significant difference （P 〉 0.05） ; the scores of HAMD, HAMA and SCL-90 of the two groups at the end of wk 4, 6, 8 wk significantly decreased （P 〈 0.01）. Compared between the two groups, the HAMD,HAMA and SCL-90 scores had significant difference at the end of wk 4, 6 and 8 （P 〈 0.01）. Main adverse reactions of the two groups were nausea, anorexia and dizziness, with no significant difference in adverse reaction rates of the two groups （P 〉 0.05）. CONCLUSION The efficacy of sertraline combined with cognitive behavior therapy is better than the single use of sertraline in the treatment of adolescent depression, and their safety is equal.