艾司西酞普兰联合认知行为治疗抑郁症临床探讨

A comparative study of combined cognitive-behavioral therapy and pharmacotherapy for depression

目的探讨艾司西酞普兰联合认知行为治疗对抑郁症患者的疗效、安全性及生活质量的影响。方法 92例门诊抑郁症患者,随机分为认知行为治疗(cognitive-behavior therapy,CBT)组30例,艾司西酞普兰组(Escitalopram,ES)和二者联合组(ESCBT)各31例。在治疗前和治疗第4、8、12、28周末,采用汉密尔顿抑郁量表(HAMD)、副反应量表(TESS)评价3组患者的抑郁状态、不良反应;采用生活质量综合评定问卷(GQOLI-74)评定治疗前及治疗后12、28周末生活质量。结果 3组脱落率比较差异无统计学意义(P>0.05)。(1)HAMD评分:治疗后第4周,3组评分均减少,药物组和联合组减少更明显(P<0.01);第8、12周,3组评分均明显减少(P<0.01),尤以联合组更明显;第28周联合组减少最明显,CBT组减少超过药物组(P<0.01)。(2)GQOLI-74评分:治疗后第12、28周,总均分均明显升高,联合组>CBT组>药物组(P<0.01)。(3)TESS评分:CBT组无不良反应,联合组与药物组差异无统计学意义(P>0.05)。结论认知行为联合艾司西酞普兰治疗抑郁症效果更好且远期疗效好、安全,患者生活质量高。

Objective To evaluate the relative efficacy of combined cognitive-behavioral therapy（CBT） and pharmacotherapy for depression（MD）.Methods A total of 92 cases with MD were randomly divided into CBT group（n=30）,escitalopram group（ES,n=31） and escitalopram combined with CBT group（ESCBT,n=31） for a 28-week observation.Hamilton Depression Rating Scale（HAMD-24） and Treatment Emergent Symptom Scale（TESS） were respectively used to assess the efficacy and side effects before treatment and after 4,8,12 and 28 weeks＇ treatment.General quality of life inventory（GQOLI-74） was used to analyze the quality of life of these patients at baseline,12 and 28 weeks as the follow-up end point.Results Three groups showed lasted effect on treatments,with the most favorable improvement in ESCBT group.Either ESCBT or ES group showed a higher decrease on the change in the HAMD than CBT at 4 and 8 weeks（P〈0.01）.However,CBT group scored a more decrease in HAMD than ES group by 28 weeks.From 8th week,the scores of GQOLI-74 in ESCBT group were significantly higher than those in the other two groups（P〈0.01）.Conclusion Although preliminary,our results suggest that the combination of CBT plus escitalopram may prove favorable in the treatment of major depression.