本文由小咖机器人翻译整理

期刊来源：JAMA

原文链接：https://doi.org/10.1001/jama.2024.5756

摘要内容如下：

重要性

每年大约有9%的美国成年人患有重度抑郁症，男性终生患病率约为17%，女性为30%。

观察

重度抑郁症的定义是情绪低落，对活动失去兴趣，以及持续至少2周的相关心理和躯体症状。评估应包括对严重程度以及自我伤害、疑似双相情感障碍、精神病症状、物质使用和并发焦虑症的风险进行结构化评估。一线治疗包括特定的心理疗法和抗抑郁药物。一项随机临床试验的网络荟萃分析报告称，认知疗法、行为激活疗法、问题解决疗法、人际疗法、短期心理动力疗法和正念心理疗法在症状改善方面均至少比没有心理疗法的常规治疗具有中等效果（标准化平均差[SMD]范围为0.50[95%CI，0.20-0.81]至0.73[95%CI，0.52-0.95]）。一项随机临床试验的网络荟萃分析显示，与安慰剂相比，21种抗抑郁药物在症状改善方面均具有小到中等的效果（SMD范围从氟西汀的0.23[95%CI，0.19-0.28]到阿米替林的0.48[95%CI，0.41-0.55]）。心理治疗结合抗抑郁药物治疗可能是首选，尤其是对于更严重或慢性抑郁症。一项随机临床试验的网络荟萃分析显示，联合治疗比单纯心理治疗（SMD，0.30[95%CI，0.14-0.45]）或单纯药物治疗（SMD，0.33[95%CI，0.20-0.47]）更能改善症状。当最初的抗抑郁药物无效时，二线药物治疗包括更换抗抑郁药物、增加第二种抗抑郁药物或增加非抗抑郁药物，根据网络荟萃分析，这些药物的成功可能性大致相同。包括系统随访和结果评估在内的协作护理计划可提高治疗效果，1项荟萃分析报告称，与常规护理相比，症状改善显著（SMD，0.42[95%CI，0.23-0.61]）。

结论和相关性

有效的一线抑郁症治疗包括特定形式的心理治疗和20多种抗抑郁药物。密切监测可显著提高治疗成功的可能性。

英文原文如下：

Abstracts

Importance  Approximately 9% of US adults experience major depression each year, with a lifetime prevalence of approximately 17% for men and 30% for women.

Observations  Major depression is defined by depressed mood, loss of interest in activities, and associated psychological and somatic symptoms lasting at least 2 weeks. Evaluation should include structured assessment of severity as well as risk of self-harm, suspected bipolar disorder, psychotic symptoms, substance use, and co-occurring anxiety disorder. First-line treatments include specific psychotherapies and antidepressant medications. A network meta-analysis of randomized clinical trials reported cognitive therapy, behavioral activation, problem-solving therapy, interpersonal therapy, brief psychodynamic therapy, and mindfulness-based psychotherapy all had at least medium-sized effects in symptom improvement over usual care without psychotherapy (standardized mean difference [SMD] ranging from 0.50 [95% CI, 0.20-0.81] to 0.73 [95% CI, 0.52-0.95]). A network meta-analysis of randomized clinical trials reported 21 antidepressant medications all had small- to medium-sized effects in symptom improvement over placebo (SMD ranging from 0.23 [95% CI, 0.19-0.28] for fluoxetine to 0.48 [95% CI, 0.41-0.55] for amitriptyline). Psychotherapy combined with antidepressant medication may be preferred, especially for more severe or chronic depression. A network meta-analysis of randomized clinical trials reported greater symptom improvement with combined treatment than with psychotherapy alone (SMD, 0.30 [95% CI, 0.14-0.45]) or medication alone (SMD, 0.33 [95% CI, 0.20-0.47]). When initial antidepressant medication is not effective, second-line medication treatment includes changing antidepressant medication, adding a second antidepressant, or augmenting with a nonantidepressant medication, which have approximately equal likelihood of success based on a network meta-analysis. Collaborative care programs, including systematic follow-up and outcome assessment, improve treatment effectiveness, with 1 meta-analysis reporting significantly greater symptom improvement compared with usual care (SMD, 0.42 [95% CI, 0.23-0.61]).

Conclusions and Relevance  Effective first-line depression treatments include specific forms of psychotherapy and more than 20 antidepressant medications. Close monitoring significantly improves the likelihood of treatment success.

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