在現實世界中，不到四分之一被診斷患有抑鬱症的患者通過藥物治療、住院治療和治療得到改善。
by 彼得·西蒙斯-2022 年 6 月 27 日
在現實生活環境中進行的一項新研究中，只有 24.2% 的抑鬱症患者對治療有反應，包括多種藥物治療、住院治療和附加心理治療。
In a new study conducted in a real-life setting, only 24.2% of patients with depression responded to treatment, including treatment with multiple drugs, hospitalization, and add-on psychotherapy.
該研究由奧地利、比利時、意大利、以色列和英國的一個國際研究小組進行，並獲得了製藥行業的資助。Lucie Bartova、Gernot Fugger 和 Siegfried Kasper 在奧地利維也納醫科大學領導了這項研究。
The study was conducted by an international group of researchers in Austria, Belgium, Italy, Israel, and the UK and had pharmaceutical industry funding. Lucie Bartova, Gernot Fugger, and Siegfried Kasper led the research at the Medical University of Vienna, Austria.
他們進行這項研究的理由是他們相信“儘管有很多有效的抗抑鬱藥 (AD) 治療，但重度抑鬱症 (MDD) 的結果往往不能令人滿意，這可能是由於對現有療法的改進利用。”
Their rationale for conducting the study was their belief that “Despite plenty of effective antidepressant (AD) treatments, the outcome of major depressive disorder (MDD) is often unsatisfactory, probably due to improvable exploitation of available therapies.”
正如研究人員所說，問題不在於抗抑鬱藥無效，而在於這些治療方法沒有得到足夠的使用。他們認為，“可用療法(available therapies)”需要更多地“利用(exploited)”。
As the researchers put it, the problem is not that antidepressants are ineffective but rather that these treatments are simply not used enough. They argued that the “available therapies” need to be “exploited” more.
他們的研究測試了這個命題。在現實生活中，MDD 患者會根據需要接受這些治療，包括多種藥物治療、住院治療和附加心理治療。如果這些治療是有效的——而且只是沒有得到足夠的使用——那麼這項研究應該顯示出極高的成功率，因為研究中的每個人都接受了部分或全部這些治療。
Their study tested this proposition. In a real-life setting, people with MDD were given these treatments as needed, including multiple medications, hospitalization, and add-on psychotherapy. If these treatments were effective—and simply not being used enough—then this study should show an extremely high success rate since everyone in the study received some or all of these treatments.
然而，他們的研究顯示出令人沮喪的結果。儘管進行了積極的治療，但只有 24.2% 的參與者被評為對治療“有反應(responding)”——更不用說從抑鬱症中恢復過來了。
Yet their study showed dismal results. Despite aggressive treatment, only 24.2% of the participants were rated as “responding” to treatment—much less recovering from depression.
研究人員將 34.3% 的人評為無反應者，並指出其餘 41.4% 的人“對治療有抵抗力(treatment-resistant)”——這是當多種藥物無法幫助人們時的污名化精神病學術語。
The researchers rated 34.3% as non-responders and noted that the remaining 41.4% became “treatment-resistant,”—which is the stigmatizing psychiatric term for when multiple medications fail to help people.
該分析包括 1279 名被診斷患有當前抑鬱症的患者。所有人都被開了一種抗抑鬱藥。此外，33.9% 住院，31.2% 接受附加心理治療（主要是 CBT）。超過一半 (58.7%) 最終服用了多種治療 MDD 的藥物，包括多種抗抑鬱藥、抗精神病藥、苯二氮卓類藥物和其他藥物組合。
The analysis included 1279 patients diagnosed with a current depressive episode. All were prescribed an antidepressant drug. In addition, 33.9% were hospitalized, and 31.2% received add-on psychotherapy (mainly CBT). More than half (58.7%) ended up on multiple medications for MDD, including multiple antidepressants, antipsychotics, benzodiazepines, and other combinations of drugs.
那麼，在所有這些選項中，誰做得最好呢？研究人員寫道，實際上沒有區別。單獨服用藥物的人，以及接受藥物和治療聯合治療的人，改善的可能性相同——同樣約為 25%。
So who did the best out of all these options? The researchers write that there was actually no difference. People who were given drugs alone, and people who received the combination of drugs and therapy, had the same likelihood of improvement—again, about 25%.
說得更清楚一點：如果你被診斷出患有抑鬱症，你有 24.2% 的機會好轉（即使經過積極的治療，包括多種藥物和住院治療）。但是，您在治療結束時被稱為“治療抵抗”的可能性大約是原來的兩倍（41.4%）並且沒有任何改善。
To put this more clearly: If you are diagnosed with depression, you have a 24.2% chance of getting better (even after aggressive treatment, including multiple drugs and hospitalization). However, you’re about twice as likely (41.4%) to be called “treatment-resistant” at the end of that treatment and see no improvement.
24.2% 的“反應”率中有多少是由於安慰劑效應？不幸的是，這項研究沒有我們可以比較這種效果的安慰劑組，但在臨床試驗中，安慰劑效果平均約為 31% ——這意味著在本研究中，預計從安慰劑中受益的人比從積極藥物治療中受益的人更多.
How much of that 24.2% “response” rate is due to the placebo effect? Unfortunately, this study had no placebo group to which we could compare this effect, but in clinical trials, the placebo effect averages about 31%—meaning that more people would be expected to benefit from a placebo than benefited from aggressive drug treatment in this study.
抗抑鬱藥有許多有害影響——例如體重增加、性功能障礙和情緒麻木——一旦開始就很難停藥。這項研究的一個含義是，即使在最好的情況下，超過 75% 的尋求治療的人都暴露於抗抑鬱藥的副作用和潛在的戒斷作用，而沒有看到藥物的益處。
Antidepressants have many harmful effects—such as weight gain, sexual dysfunction, and emotional numbing—and are challenging to discontinue once started. One implication of this study is that even in the best-case scenario, more than 75% of those seeking treatment are exposed to the adverse effects and potential withdrawal effects of antidepressants without seeing a benefit from the drug.
在之前對同一組參與者進行的一項研究中，研究人員發現，對於患有嚴重抑鬱症、自殺傾向、合併焦慮症或既往抑鬱症發作的患者，抗抑鬱藥治療最不可能成功。也就是說，抗抑鬱藥最不可能對那些服用最激進的人起作用——那些有自殺傾向和症狀嚴重的人。
In a previous study on the same group of participants, the researchers found that antidepressant treatment was least likely to be successful in patients with severe depression, suicidality, comorbid anxiety, or previous episodes of depression. That is, antidepressants are least likely to work for the people who are given them most aggressively—those who are suicidal and have severe symptoms.
在本研究中，研究人員關注的是附加心理治療似乎沒有幫助這一事實，而不是全面的低反應率。他們利用附加療法的失敗來推測 MDD 的“複雜生物學”起源。
In the present study, the researchers focused on the fact that add-on psychotherapy did not seem to help rather than on the low response rates across the board. They use the failure of add-on therapy to theorize about a proposed “complex biological” origin for MDD.
他們寫道：“應該強調的是，在我們的成年 MDD 住院和門診患者群體中，額外 [心理治療] 的使用與更好的治療結果無關，這可能強調了 MDD 和門診患者潛在的複雜生物學相互關係的基本作用。它的治療。”
They write, “It should be highlighted that the employment of additional [psychotherapy] was not associated with a superior treatment outcome in our population of adult MDD in- and outpatients, which might emphasize the fundamental role of the underlying complex biological interrelationships in MDD and its treatment.”
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製藥巨頭靈北公司資助了這項研究。研究人員還與該行業有許多財務聯繫：
Pharmaceutical giant Lundbeck funded the research. The researchers also had numerous financial ties to the industry:
Bartova 博士獲得了來自 AOP Orphan、Medizin Medien Austria、Vertretungsnetz、Schwabe Austria、Janssen 和 Angelini 的旅行補助金和顧問/演講者酬金。Dold 博士獲得了 Janssen-Cilag 的旅行補助金和顧問/演講者酬金。Zohar 博士獲得了 Lundbeck、Servier 和 Pfizer 的資助/研究支持；他曾擔任 Servier、Pfizer、Solvay 和 Actelion 的顧問或顧問委員會成員；他曾在 Lundbeck、GlaxoSmithKline、Jazz 和 Solvay 的演講者辦公室任職。Mendlewicz 博士是靈北國際神經科學基金會董事會成員和施維雅顧問委員會成員。Souery 博士獲得了葛蘭素史克和靈北公司的資助/研究支持；他曾擔任阿斯利康、百時美施貴寶、禮來、楊森、和靈北。蒙哥馬利博士曾擔任阿斯利康、Bionevia、百時美施貴寶、Forest、葛蘭素史克、Grunenthal、Intellect Pharma、強生、禮來、靈北、默克、Merz、M’s Science、Neurim、Otsuka、 Pierre Fabre、輝瑞、Pharmaneuroboost、Richter、Roche、Sanofi、Sepracor、Servier、Shire、Synosis、Takeda、Theracos、Targacept、Transcept、UBC、Xytis 和 Wyeth。Fabbri 博士得到了 Fondazione Umberto Veronesi (https://www.fondazioneveronesi.it) 的支持。Serretti 博士曾擔任 Abbott、Abbvie、Angelini、AstraZeneca、Clinical Data、Boehringer、Bristol-Myers Squibb、Eli Lilly、GlaxoSmithKline、Innovapharma、Italfarmaco、Janssen、Lundbeck、Naurex、輝瑞、Polifarma、Sanofi、和服務商。在過去的三年裡，博士。Kasper 獲得了 Angelini、Celegne GmbH、Eli Lilly、Janssen-Cilag Pharma GmbH、KRKA-Pharma、Lundbeck A/S、萌蒂製藥、Neuraxpharm、輝瑞、賽諾菲、Schwabe、Servier、 Shire、Sumitomo Dainippon Pharma Co. Ltd.、sun Pharma 和武田。所有其他作者聲明他們沒有利益衝突。
Dr. Bartova has received travel grants and consultant/speaker honoraria from AOP Orphan, Medizin Medien Austria, Vertretungsnetz, Schwabe Austria, Janssen and Angelini. Dr. Dold has received travel grants and consultant/speaker honoraria from Janssen-Cilag. Dr. Zohar has received grant/research support from Lundbeck, Servier, and Pfizer; he has served as a consultant or on the advisory boards for Servier, Pfizer, Solvay, and Actelion; and he has served on speakers’ bureaus for Lundbeck, GlaxoSmithKline, Jazz, and Solvay. Dr. Mendlewicz is a member of the board of the Lundbeck International Neuroscience Foundation and of the advisory board of Servier. Dr. Souery has received grant/research support from GlaxoSmithKline and Lundbeck; and he has served as a consultant or on advisory boards for AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Janssen, and Lundbeck. Dr. Montgomery has served as a consultant or on advisory boards for AstraZeneca, Bionevia, Bristol-Myers Squibb, Forest, GlaxoSmithKline, Grunenthal, Intellect Pharma, Johnson & Johnson, Lilly, Lundbeck, Merck, Merz, M’s Science, Neurim, Otsuka, Pierre Fabre, Pfizer, Pharmaneuroboost, Richter, Roche, Sanofi, Sepracor, Servier, Shire, Synosis, Takeda, Theracos, Targacept, Transcept, UBC, Xytis, and Wyeth. Dr. Fabbri has been supported by Fondazione Umberto Veronesi (https://www.fondazioneveronesi.it). Dr. Serretti has served as a consultant or speaker for Abbott, Abbvie, Angelini, AstraZeneca, Clinical Data, Boehringer, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Innovapharma, Italfarmaco, Janssen, Lundbeck, Naurex, Pfizer, Polifarma, Sanofi, and Servier. Within the last three years, Dr. Kasper received grants/research support, consulting fees, and/or honoraria from Angelini, Celegne GmbH, Eli Lilly, Janssen-Cilag Pharma GmbH, KRKA-Pharma, Lundbeck A/S, Mundipharma, Neuraxpharm, Pfizer, Sanofi, Schwabe, Servier, Shire, Sumitomo Dainippon Pharma Co. Ltd., s
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Bartova, L., Fugger, G., Dold, M., Swoboda, MMM, Zohar, J., Mendlewicz, J., 。. . & Kasper, S. (2021)。結合心理藥物療法和心理療法與重度抑鬱症的更好治療結果無關——來自歐洲抗性抑鬱症研究小組的證據。精神病學研究雜誌，141，167-175。https://doi.org/10.1016/j.jpsychires.2021.06.028 （鏈接）
Bartova, L., Fugger, G., Dold, M., Swoboda, M. M. M., Zohar, J., Mendlewicz, J., . . . & Kasper, S. (2021). Combining psychopharmacotherapy and psychotherapy is not associated with better treatment outcome in major depressive disorder – evidence from the European Group for the Study of Resistant Depression. Journal of Psychiatric Research, 141, 167-175. https://doi.org/10.1016/j.jpsychires.2021.06.028 (Link)
彼得·西蒙斯彼得西蒙斯是一位心理學學術研究員。現在，作為一名科普作家，他試圖讓外行人了解有時難以捉摸的精神病學研究世界。作為 Mad in America 博客和個人故事的編輯，他重視那些對精神病學系統有生活經驗的人的敘述，並分享生物醫學模型的替代方案。
Peter SimonsPeter Simons was an academic researcher in psychology. Now, as a science writer, he tries to provide the layperson with a view into the sometimes inscrutable world of psychiatric research. As an editor for blogs and personal stories at Mad in America, he prizes the accounts of those with lived experience of the psychiatric system and shares alternatives to the biomedical model.