探討抗憂鬱劑合併認知行為治療於憂鬱症伴隨物質使用疾患患者之療效：系統性文獻回顧、統合分析與臨床試驗計畫書

Efficacy of antidepressants in combination with cognitive behavior therapy in the treatment of patients with co-occurring depression and substance use disorder: a systematic review, meta-analysis and clinical trial protocol

姚乃慈(Nai-Tzu Yao)

指導教授 ： 陳祈玲

國立臺灣大學/醫學院/臨床醫學研究所/碩士(2021年)

https://doi.org/10.6342/NTU202103369

摘要

目的：抗抑鬱劑和認知行為治療均可有效降低憂鬱症和物質使用疾患的症狀。然而，目前針對合併使用這兩項治療的療效研究僅有少數且結果尚無定論。此外，過去之統合分析側重於特定族群，且收納之研究未排除非使用認知行為治療，導致具醫學實證之心理治療的效果被低估。因此，本研究的目的是進行系統性文獻回顧並使用統合分析來探討合併使用抗抑鬱劑及認知行為治療對憂鬱症伴隨物質使用疾患的患者的療效。
研究方法：本研究對隨機對照試驗進行統合分析。針對 2000 年後至 2021 年 3 月之間所發表之研究於PubMed、Embase、PsychINFO 和 Cochrane等資料庫進行系統性審查。最終本研究共收納9 項隨機對照試驗，總共分析 761 名受試者。療效之測量為憂鬱症和物質使用疾患之結果，此外，本研究也進行次族群分析以進一步探討合併治療在不同族群中之療效。
結果：在憂鬱症結果方面，與使用安慰劑加上認知行為治療組相比，合併治療組的治療緩解效果顯著（p=0.02）。針對量表分數百分比的平均變化，合併治療組比安慰劑加上認知行為治療組下降了百分之三（p=0.002），而憂鬱症評分量表分數的平均變化在組間沒有顯著差異（p=0.09）。在物質使用疾患結果方面，組間物質使用的數量或頻率沒有顯著差異（p=0.86，p=0.46）。在次族群分析中，在青少年和成人族群並無發現憂鬱症療效的具顯著性差異。
結論：本研究結果顯示，在認知行為治療中加入抗憂鬱劑並沒有減少物質的使用，然而，此合併治療可能有效改善同時患有憂鬱症和物質使用疾患病人的憂鬱症症狀。此外，次族群分析中納入之隨機對照臨床試驗數量有限因而無法獲得具檢定力之結論，尚待未來進行更多臨床試驗來研究合併治療在這些族群中的療效。

關鍵字

憂鬱症 ； 物質使用疾患 ； 抗憂鬱劑 ； 認知行為治療 ； 統合分析 ； 系統性文獻回顧

並列摘要

Background and Aims: Both antidepressants and cognitive behavior therapy (CBT) effectively reduce symptoms of depression and substance use disorder. However, only a few research studies have been found on combining these therapies, and the results remain inconclusive. Furthermore, previous meta-analyses focused on the specific population and did not exclude studies with non-CBT therapy, which may ignore the effect of evidence-based psychotherapy. Therefore, the aim of the study is to use meta-analysis to investigate the efficacy of the combined antidepressants and cognitive behavioral therapy in patients with co-occurring depression and substance-dependent.
Design, Setting, and Participants: A meta-analysis of randomized-controlled trials was conducted. Articles from PubMed, Embase, PsychINFO and Cochrane published after the year 2000 up to March 2021 were systematically reviewed. A total of 9 trials were selected, and 761 subjects were included in the analysis.
Measurements: The efficacy outcome measures were depression outcomes and substance use disorder. The subgroup analysis was conducted to examine the efficacy of combination therapy in different populations.
Findings: In the effect of treatments on depression outcome, the effect of treatment remission was shown significantly in the combination therapy group compared to the Placebo plus CBT group (p=0.02). For mean change of score percentage, a decrease of 3% was found in combination therapy group than Placebo plus CBT group (p=0.002), while no significant difference was shown between groups in mean change of scores in depression rating scales (p=0.09). On the substance use outcome, no significant difference was shown between groups in either quantity or frequency of substance use (p=0.86, p=0.46). In the subgroup analysis, no group significance for depression efficacy was found in adolescents and adults.
Conclusions: Our findings suggest that adding the antidepressant to CBT therapy did not reduce the use of substances, however, this therapy might effectively improve the depression symptoms. Due to limited numbers of the included RCTs for the subgroups, more research is needed further to investigate the efficacy of combination therapy in these populations.

並列關鍵字

depression ； substance use disorder ； antidepressants ； cognitive behavior therapy ； meta-analysis ； systematic review

參考文獻

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