Data Sheet 1_Enduring effects of psychotherapy, antidepressants and their combination for depression: a systematic review and meta-analysis.zip

IntroductionAlthough depressive disorders are frequently associated with relapses, the sustained efficacy of therapies after their termination has been insufficiently investigated.
ObjectiveThe aim of this study was to evaluate the current evidence of enduring effects of psychotherapy, antidepressants and their combination after the end of treatment.
MethodsPubMed and PsychINFO were systematically screened according to PRISMA guidelines (except for preregistration). Only randomized controlled trials (RCTs) between 1980 and 2022 comparing the efficacy of psychotherapy, antidepressants and their combination in adult depression at follow-up at least 12 months after termination of therapy, which could be acute phase, maintenance or relapse prevention therapy, were included. Risk of bias was assessed by using the Cochrane risk of bias tool.
ResultsIn total 19 RCTs with a total of 1154 participants were included. Psychotherapy was significantly superior to pharmacotherapy regarding relapse rates and Beck Depression Inventory scores at follow-up after acute treatment in two of nine RCTs. Combined treatment performed significantly better than pharmacotherapy, but not psychotherapy, regarding relapse and remission in five out of nine RCTs at least 12 months after treatment termination. Pairwise meta-analyses indicated a superiority of combined treatment compared to pharmacotherapy alone regarding relapse, recurrence, and rehospitalization rates (RR=0.60, 95%-CI: 0.37-0.97, p=.041) and for psychotherapy compared to pharmacotherapy alone regarding relapse and recurrence rates (RR=0.58, 95%-CI: 0.38-0.89, p=.023), however comparative treatment effects between psychotherapy and combined treatment were insignificant.
ConclusionsCurrent findings suggest a superiority of psychotherapy and combined treatment over pharmacotherapy alone in major depressive disorder depression. Major limitations were a low number of studies reporting follow-up data after termination of study periods and a heterogeneity in definitions of treatment outcomes. Practice guidelines and participatory decision-making processes for the choice of treatment should consider the current knowledge on long-term effects of antidepressant therapy methods more than has been the case to date.

引言：尽管抑郁症常伴随症状复发，但治疗终止后各类疗法的持续疗效仍未得到充分研究。
研究目的：本研究旨在评估治疗结束后，心理治疗、抗抑郁药物及其联合疗法的长期疗效的现有证据。
研究方法：本研究按照系统评价与Meta分析优先报告条目（Preferred Reporting Items for Systematic Reviews and Meta-Analyses, PRISMA）指南对PubMed及PsychINFO数据库开展系统性检索（预注册环节除外）。仅纳入1980年至2022年间发表的随机对照试验（randomized controlled trial, RCT），此类研究需比较心理治疗、抗抑郁药物及其联合疗法针对成人抑郁症的疗效，且随访时间需覆盖治疗终止后至少12个月，治疗类型可涵盖急性期治疗、维持治疗或复发预防治疗。本研究采用Cochrane偏倚风险评估工具对纳入研究的偏倚风险进行评价。
研究结果：最终共纳入19项RCT，涉及1154名受试者。在9项急性期治疗后随访的研究中，有2项结果显示，心理治疗在症状复发率及贝克抑郁量表（Beck Depression Inventory, BDI）评分方面显著优于药物治疗。在治疗终止后至少12个月的随访中，9项研究里有5项结果显示，联合疗法在症状复发与临床缓解率方面显著优于单一药物治疗，但与单一心理治疗相比无显著优势。两两Meta分析结果显示：相较于单一药物治疗，联合疗法在症状复发、疾病复燃及再住院率方面均更具优势（相对风险RR=0.60，95%置信区间CI：0.37-0.97，p=0.041）；心理治疗相较于单一药物治疗，在症状复发及疾病复燃方面更具优势（RR=0.58，95%CI：0.38-0.89，p=0.023），但心理治疗与联合疗法之间的治疗效应差异无统计学意义。
研究结论：现有研究结果表明，针对重性抑郁症，心理治疗及联合疗法的疗效均优于单一药物治疗。本研究的主要局限性在于：报告研究周期结束后随访数据的研究数量较少，且不同研究对治疗结局的定义存在异质性。临床实践指南及治疗选择的参与式决策流程，应比当前更多地纳入关于抗抑郁疗法长期疗效的现有研究证据。