Terapia cognitivo-comportamental para depressão resistente ao tratamento em adultos e adolescentes: uma revisão sistemática

Zakhour, Stephanie; Nardi, Antonio E.; Levitan, Michelle; Appolinario, Jose Carlos

doi:10.1590/2237-6089-2019-0033

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Sumário

Review Article • Trends Psychiatry Psychother. 42 (1) • Jan-Mar 2020 • https://doi.org/10.1590/2237-6089-2019-0033 copiar

Terapia cognitivo-comportamental para depressão resistente ao tratamento em adultos e adolescentes: uma revisão sistemática

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

Objetivos

Realizar uma revisão sistemática sobre o uso da terapia cognitivo-comportamental (TCC) e sua eficácia no tratamento da depressão resistente ao tratamento em adultos e adolescentes.

Métodos

Realizamos uma revisão sistemática utilizando os critérios do Prisma Guidelines, nos seguintes bancos de dados: PubMed, SciELO, Psychiatry Online, Scopus, PsycArticles, Science Direct e Journal of Medical Case Reports. Estudos controlados randomizados, estudos abertos e relatos de casos foram incluídos neste estudo.

Resultados

A pesquisa retornou um total de 1.580 artigos, publicados de 1985 até 2017. Após aplicarmos os critérios de inclusão, 17 artigos foram selecionados, seus textos completos foram lidos e 8 foram incluídos nesta revisão. Do total, quatro eram estudos controlados randomizados com adultos, tendo um incluído um período de seguimento pós-estudo; dois eram estudos controlados randomizados com adolescentes, tendo um apresentado dados de seguimento; um era um estudo aberto; e o último era um relato de caso. Os estudos apresentaram boa qualidade e evidências robustas sobre o tópico abordado.

Conclusões

A combinação de TCC com tratamento medicamentoso para pacientes resistentes ao tratamento mostra uma diminuição dos sintomas depressivos. A TCC pode ser um tipo eficaz de terapia para adultos e adolescentes com depressão resistente ao tratamento.

Terapia cognitivo-comportamental; transtorno depressivo maior; transtorno depressivo resistente a tratamento

First author	Year of publication	Study design	Intervention	Frequency and duration of intervention	Session length	Duration of follow-up	Instruments	Main findings
Brent³	2008	RCT	TAU, CBT	12 weeks	TAU: 30-60 minutes CBT: 60-90 minutes	6 and 12 weeks	CDRS-R, BDI, SIQ-Jr, CGI-I, CGAS	CBT plus a switch to either medication regimen showed a higher response rate (54.8%) than a medication switch alone (40.5%) and there was no difference in response rate between venlafaxine and a second SSRI.
Nakagawa⁶	2017	RCT	TAU, Individual CBT	16 sessions + 4 additional sessions	50 minutes	12 months	GRID-HDRS, QIDS-SR, HPQ	Patients with TRD may benefit from supplementing TAU with CBT.
Wiles¹⁰	2013	RCT	TAU, Individual CBT	12 sessions + 6 additional sessions	50-60 minutes	12 months	BDI, ICD-10	CBT + TAU was effective for reducing depressive symptoms and improving quality of life in patients with TRD.
Wiles¹¹	2016	Follow-Up RCT	TAU, Individual CBT	12 sessions + 6 additional sessions	50-60 minutes	3-5 years	BDI, SF-12, PHQ-9, GAD-7, EQ-5D-5L	The CBT intervention reduced depressive symptoms and improved quality of life over an average of 46 months.
Lopez¹²	2014	RCT	TAU, Individual CBT	18 sessions	NM	IAI	BDI, QIDS	Participants showed a more rapid reduction in depressive symptoms over time and more CBT participants reached full symptom remission.
Emslie¹³	2010	RCT	TAU, CBT	12 weeks	TAU: 30-60 minutes CBT: 60-90 minutes	24 weeks	CDRS-R, BDI, CGAS, CGIS, BHS, SIQ-Jr, CBQ-A, DUS-U, DUS-I	Of the 334 adolescents, only 261 participants (78.1%) were included in the 24-week assessment and 20% did not complete the assessment. The results showed that only 38.9% of 334 adolescents on the TORDIA trial achieved remission by 24 weeks.
Miller¹⁴	1985	Open trial	TAU, CBT, SST	28 sessions over a period averaging 22 weeks	NM	IAI	BDI, HDRS	4 of the 6 patients exhibited complete improvement on measures of depression symptomatology.
Bannan¹⁵	2005	Case report	Venlafaxine, CBT	12 sessions (CBT) 375 mg daily (venlafaxine)	NM	IAI	BDI, BHI, BAI	Clear improvements on assessments of mood and hopelessness and in social and occupational functioning.

	Brent³	Nakagawa⁷	Wiles¹²	Lopez¹³
Description of subjects
1. Diagnostic method and inclusion/exclusion criteria	2	2	2	1
2. Documentation/demonstration of reliability of diagnostic methodology	1	1	2	0
3. Description of relevant comorbidities	2	2	2	1
4. Description of numbers of subjects screened, included, and excluded	2	2	2	2
Definition and delivery of treatment
5. Treatment(s) (including control/comparison groups) are sufficiently described or referenced to allow for replication	2	2	2	2
6. The treatment being studied is treatment delivered	2	2	2	2
7. Therapist training and level of experience in the treatment(s) under investigation	2	2	2	2
8. Therapist supervision while treatment is being provided	2	1	2	2
9. Description of concurrent treatments allowed and administered	2	1	1	0
Outcome measures
10. Validated outcome measure(s)	2	2	2	2
11. Primary outcome measure(s) specified in advance	2	2	2	0
12. Outcome assessment by raters blinded to treatment group and with established reliability	2	0	0	0
13. Discussion of safety and adverse events during study treatment(s)	2	0	0	0
14. Assessment of long-term post-termination outcome	1	1	1	1
Data analysis
15. Intent-to-treat method for data analysis, primary outcome	2	2	2	0
16. Description of dropouts and withdrawals	2	2	2	1
17. Appropriate statistical tests	2	2	2	1
18. Adequate sample size	2	2	1	1
19. Appropriate consideration of therapist and site effects	2	1	1	1
Treatment assignment
20. A priori relevant hypotheses that justify comparison group(s)	2	1	2	1
21. Comparison group(s) from same population and time frame as experimental group	2	2	2	2
22. Randomized assignment to treatment groups	2	2	2	2
Overall quality of study
23. Balance of allegiance to types of treatment by practitioners	2	1	1	1
24. Conclusions justified by sample, measures, and data analysis	2	2	2	2
25. Omnibus rating	7	5	6	5

	Wiles¹⁴	Emslie¹⁶
Description of subjects
1. Diagnostic method and inclusion/exclusion criteria	2	2
2. Documentation/demonstration of reliability of diagnostic methodology	2	1
3. Description of relevant comorbidities	2	2
4. Description of numbers of subjects screened, included, and excluded	2	2
Definition and delivery of treatment
5. Treatment(s) (including control/comparison groups) are sufficiently described or referenced to allow for replication	2	2
6. The treatment being studied is treatment delivered	2	2
7. Therapist training and level of experience in the treatment(s) under investigation	2	2
8. Therapist supervision while treatment is being provided	2	2
9. Description of concurrent treatments allowed and administered	1	2
Outcome measures
10. Validated outcome measure(s)	2	1
11. Primary outcome measure(s) specified in advance	2	2
12. Outcome assessment by raters blinded to treatment group and with established reliability	0	1
13. Discussion of safety and adverse events during study treatment(s)	0	2
14. Assessment of long-term post-termination outcome	1	1
Data analysis
15. Intent-to-treat method for data analysis, primary outcome	2	2
16. Description of dropouts and withdrawals	2	2
17. Appropriate statistical tests	1	1
18. Adequate sample size	1	2
19. Appropriate consideration of therapist and site effects	1	2
Treatment assignment
20. A priori relevant hypotheses that justify comparison group(s)	2	2
21. Comparison group(s) from same population and time frame as experimental group	2	2
22. Randomized assignment to treatment groups	2	2
Overall quality of study
23. Balance of allegiance to types of treatment by practitioners	1	2
24. Conclusions justified by sample, measures, and data analysis	2	2
25. Omnibus rating	6	7

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[1] Correspondence: Stephanie Zakhour. Ambulatório de Depressão Resistente ao Tratamento (DeReTrat) Instituto de Psiquiatria (IPUB), Universidade Federal do Rio de Janeiro (UFRJ) Av. Vencelaus Brás, 71, Campus da Praia Vermelha 22290-140 - Rio de Janeiro, RJ - Brazil Tel.: + 55 (21) 964426645 E-mail: stephaniezakhour@hotmail.com