心理治疗在难治性抑郁中的应用

Application of psychotherapy in treatment-resistant depression

难治性抑郁(treatment-resistant depression,TRD)具有高自杀率和高复发率的特征。药物治疗对TRD的效果并不理想,且存在明显的不良反应。心理治疗是众多指南中被推荐用于治疗抑郁症的重要方法,但既往研究和临床实践对心理治疗在TRD中的应用关注较少。因此,本文通过回顾近年来心理治疗干预TRD的相关研究,综述心理治疗对TRD抑郁症状、自杀和复发风险的干预效果,并进一步阐述可能的疗效机制,包括通过处理TRD的早年创伤来改善其人际功能,从而缓解症状;干预TRD患者的失功能性认知模式来帮助他们应对负性生活事件,从而减少压力和抑郁情绪。在此基础上,结合已有研究的局限性,指出未来研究可以考虑的方向:提高研究质量;增加行为学和生理学指标以进一步澄清疗效机制;明确心理治疗与其他治疗的配合方式;探索团体和线上治疗等形式的心理治疗以增加TRD心理治疗的可及性。

Treatment-resistant depression(TRD)is characterized by a high suicide rate and a high recurrence rate.The effect of the medicine on TRD is not ideal with obvious side effects.Psychotherapy is an important method recommended in many guidelines for the treatment of depression.However,previous studies and clinical applications have paid little attention to the application of psychotherapy in TRD.Therefore,based on recent studies,this paper reviews the effects of psychotherapy on the depressive symptoms,suicide risk,and recurrence risk in TRD.Further,the possible therapeutic mechanisms are discussed,including the improvement of interpersonal function by dealing with early trauma in TRD,therefore alleviating symptoms;intervening in the dysfunctional cognitive pattern of TRD to help them cope with negative life events,therefore reducing stress and depression.Combined with the limitations of existing studies,the following directions can be considered in the future:improving the research quality,measuring behavioral and physiological indicators to further clarify the therapeutic mechanism,identifying ways in which psychotherapy can be combined with other treatments,exploring the group and online therapy to increase accessibility of psychotherapy for TRD.