Advances in treatment Depression-specific psychotherapies Pharmacotherapy and manual-driven depression-specific psychotherapy are both effective treatments for unipolar depression, either as monotherapies, or in combination.97,98 Although similar results are reported for depression-specific psychotherapy in primary-care samples, fewer published works are available in this area than in psychiatric samples.99,100 These studies suggest that inter personal psychotherapy alone, or in combination with pharmacotherapy, is effective for the acute treatment of depression.
In a clinical trial of inpatients with depression,101 response rates of patients receiving a combination of interpersonal psychotherapy (modified for inpatients) and pharmacotherapy were higher than those of patients receiving pharmacotherapy alone. The effects of acute interpersonal psychotherapy can be sustained even after remission.101,102 Similarly, several trials in the USA and Europe continue to support the acute efficacy of cognitive therapy and its usefulness as an intervention to achieve full remission and reduce the risk of recurrence.103,104 Research has also indicated that cognitive behavioural therapy can be effectively implemented in non-traditional ways—eg, via telephone and the internet—that accommodate the unique needs of primary care practice.105,106 A randomised clinical trial comparing cognitive behavioural therapy and interpersonal psychotherapy in participants with major depression found that, on average, the treatments were equally effective. However, for a subset of patients with severe depression (Montgomery-Åsberg Depression Rating Scale [MADRS] score >30), those allocated to cognitive behaviour therapy had a greater percentage improvement in MADRS score and also had a greater likelihood of response than did those receiving interpersonal psychotherapy. No difference between the two treatments was noted for individuals with melancholic depression.107 For patients with three or more previous depressive episodes, mindfulness-based cognitive therapy has an additive benefit to usual care. Problem-solving therapy might be as effective as alternative psychotherapies and pharmacotherapies for the treatment of depression, and more effective than control treatments, and might be particularly well-suited for use in primary care.108,109
ความก้าวหน้าในการรักษาเฉพาะโรคซึมเศร้า psychotherapies Pharmacotherapy และขับเคลื่อนด้วยตนเองเฉพาะภาวะซึมเศร้าจิตบำบัดมีทั้งการรักษามีประสิทธิภาพสำหรับโรคซึมเศร้า unipolar เป็น monotherapies หรือ ใน combination.97,98 แม้ว่ามีรายงานผลคล้ายการจิตบำบัดเฉพาะโรคซึมเศร้าในตัวอย่างหลักดูแล ประกาศงานน้อยมีในพื้นที่นี้กว่า samples.99,100 จิตแพทย์แนะนำการศึกษานี้ที่อินเตอร์จิตแพทย์ส่วนบุคคลเพียงอย่างเดียว หรือร่วมกับ pharmacotherapyมีประสิทธิภาพในการรักษาโรคซึมเศร้าเฉียบพลันIn a clinical trial of inpatients with depression,101 response rates of patients receiving a combination of interpersonal psychotherapy (modified for inpatients) and pharmacotherapy were higher than those of patients receiving pharmacotherapy alone. The effects of acute interpersonal psychotherapy can be sustained even after remission.101,102 Similarly, several trials in the USA and Europe continue to support the acute efficacy of cognitive therapy and its usefulness as an intervention to achieve full remission and reduce the risk of recurrence.103,104 Research has also indicated that cognitive behavioural therapy can be effectively implemented in non-traditional ways—eg, via telephone and the internet—that accommodate the unique needs of primary care practice.105,106 A randomised clinical trial comparing cognitive behavioural therapy and interpersonal psychotherapy in participants with major depression found that, on average, the treatments were equally effective. However, for a subset of patients with severe depression (Montgomery-Åsberg Depression Rating Scale [MADRS] score >30), those allocated to cognitive behaviour therapy had a greater percentage improvement in MADRS score and also had a greater likelihood of response than did those receiving interpersonal psychotherapy. No difference between the two treatments was noted for individuals with melancholic depression.107 For patients with three or more previous depressive episodes, mindfulness-based cognitive therapy has an additive benefit to usual care. Problem-solving therapy might be as effective as alternative psychotherapies and pharmacotherapies for the treatment of depression, and more effective than control treatments, and might be particularly well-suited for use in primary care.108,109
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