眼动脱敏与再加工和舍曲林治疗伴童年创伤的 青少年抑郁症的效果比较Eye movement desensitization and reprocessing versus sertraline in the treatment of depressed adolescents with childhood trauma
Description
背景
伴童年创伤的青少年抑郁症患儿的抑郁症状常更重，且对药物不敏感。眼动脱敏与再加工 （EMDR）在治疗创伤有关的心理疾病中发挥了其独特的优势，近年来也逐渐用于抑郁症的治疗并得到了一定的成果， 但国内相关研究较少。
目的
比较 EMDR 和舍曲林治疗伴童年创伤的青少年抑郁症患儿的效果差异，以探索更优的临 床治疗方案，并为进一步推广 EMDR 的临床应用提供科学数据。
方法
收集 2020 年 12 月至 2022 年 2 月就诊于遵义 医科大学附属医院心理门诊的 60 例伴童年创伤的青少年抑郁症患儿为研究对象。依据随机数字表法分为舍曲林治疗 组和 EMDR 治疗组，各 30 例。舍曲林治疗组单纯服用盐酸舍曲林片，第 1 周剂量为 50 mg/d，第 2 周逐渐加量至 100 mg/d，在第 4 周末若存在消极观念或自伤行为可将舍曲林加量至 200 mg/d，总疗程为 8 周。EMDR 治疗组进行 EMDR 治疗，1 次 / 周，总疗程为 8 周。采用贝克抑郁自评量表（BDI）、贝克焦虑自评量表（BAI）和心理弹性量表（CD-RISC） 对两组患儿治疗前、治疗 4 周后、治疗 8 周后的心理情况进行评价。
结果
研究过程中存在 5 例脱落病例，最终完成 试验 55 例，其中舍曲林治疗组 28 例，EMDR 治疗组 27 例。时间和组间对两组患儿 BDI、BAI、CD-RISC 评分存在交 互作用（P<0.05）；时间对两组患儿 BDI、BAI、CD-RISC 评分主效应显著（P<0.05）；组间对两组患儿 BAI、CDRISC 评分主效应显著（P<0.05）；组间对 BDI 评分主效应不显著（P>0.05）。治疗 4 周后 EMDR 治疗组患儿 CDRISC 评分高于舍曲林治疗组（P<0.05）。治疗 8 周后 EMDR 治疗组患儿 CDRI-SC 评分高于舍曲林治疗组，BDI、BAI 评 分低于舍曲林治疗组（P<0.05）。舍曲林治疗组患儿治疗 8 周后 BDI 评分低于治疗前、治疗 4 周后（P<0.05）；舍曲 林治疗组患儿治疗 8 周后 BAI 评分低于治疗 4 周后（P<0.05）。EMDR 治疗组患儿治疗 4、8 周后 BDI、BAI 评分均低 于治疗前，CD-RISC 评分高于治疗前（P<0.05）；EMDR 治疗组患儿 8 周后 BDI、BAI 评分均低于治疗 4 周后，CDRISC 评分高于治疗 4 周后（P<0.05）。
结论
舍曲林能部分改善伴童年创伤的青少年抑郁症患儿的抑郁和焦虑情绪， 但对于心理弹性的提升效果不显著；EMDR 不仅能够有效改善伴童年创伤抑郁症患儿的抑郁和焦虑情绪，还能提升心 理弹性，可作为其优选治疗方案。
Background
Depressed adolescents with childhood trauma often present with more severe symptoms and are insensitive to drugs. Eye movement desensitization and reprocessing （EMDR） plays a unique role in the treatment of trauma-related mental disorders. It has been gradually used in the treatment of depression and has achieved certain results recently，but there are few related studies in China.
Objective
To assess whether EMDR has better efficacy than sertraline in the treatment of depressed adolescents with childhood trauma using a comparative analysis，providing scientific evidence for further promoting clinical application of EMDR.
Methods
Sixty depressed adolescents with childhood trauma were recruited from Psychological Clinic，Affiliated Hospital of Zunyi Medical University from December 2020 to February 2022, and equally randomized into a sertraline group and an EMDR group. Sertraline group received a eight-week treatment with sertraline：the dose was 50 mg/d in the first week and gradually increased to 100 mg/d in the second week，and could be increased to 200 mg/d at the end of the fourth week if the patients had negative ideas or self-injurious behavior. The EMDR group received EMDR treatment, once a week，for a total of 8 weeks. The Beck Depression Inventory（BDI)，Beck Anxiety Inventory (BAI）and Connor-Davidson Resilience Scale （CD-RISC）were used to evaluate the psychological status of the two groups before treatment, four weeks and eight weeks after treatment.
Results
Except for five dropouts，the remaining cases who completed the trial were finally included，including 28 in the sertraline group and 27 in the EMDR group. The treatment type and treatment duration had interactive effects on the BDI，BAI and CD-RISC scores of the two groups（P<0.05). The treatment duration had significant main effects on the BDI，BAI and CD-RISC scores of the two groups（P<0.05). The treatment type had significant main effects on BAI and CD-RISC scores of the two groups （P<0.05)，but produced no significant effects on the BDI scores （P>0.05). EMDR group had higher average CDRI-SC score than sertraline group at four weeks after treatment（P<0.05). EMDR group had higher average CDRI-SC score，and lower average BDI and BAI scores than sertraline group at eight weeks after treatment （P<0.05). In the sertraline group，the average BDI score at eight weeks after treatment was much lower than that at baseline or four weeks after treatment （P<0.05)，and the average BAI score at eight weeks after treatment was much lower than that at four weeks of treatment（P<0.05). In the EMDR group，the average BDI and BAI scores decreased significantly while the average CD-RISC score increased significantly at both four and eight weeks after treatment compared with baseline levels （P<0.05）. And compared with four-week treatment，eight-week treatment lowered the average BDI and BAI scores more significantly，and increased the average CD-RISC score more significantly（P<0.05).
Conclusion
Sertraline could partially improve depression and anxiety in depressed adolescents with childhood trauma，but had no significant improvement of psychological elasticity. In contrast，EMDR could effectively improve the depression and anxiety as well as psychological elasticity，so it could be used as the preferred treatment.
伴童年创伤的青少年抑郁症患儿的抑郁症状常更重，且对药物不敏感。眼动脱敏与再加工 （EMDR）在治疗创伤有关的心理疾病中发挥了其独特的优势，近年来也逐渐用于抑郁症的治疗并得到了一定的成果， 但国内相关研究较少。
目的
比较 EMDR 和舍曲林治疗伴童年创伤的青少年抑郁症患儿的效果差异，以探索更优的临 床治疗方案，并为进一步推广 EMDR 的临床应用提供科学数据。
方法
收集 2020 年 12 月至 2022 年 2 月就诊于遵义 医科大学附属医院心理门诊的 60 例伴童年创伤的青少年抑郁症患儿为研究对象。依据随机数字表法分为舍曲林治疗 组和 EMDR 治疗组，各 30 例。舍曲林治疗组单纯服用盐酸舍曲林片，第 1 周剂量为 50 mg/d，第 2 周逐渐加量至 100 mg/d，在第 4 周末若存在消极观念或自伤行为可将舍曲林加量至 200 mg/d，总疗程为 8 周。EMDR 治疗组进行 EMDR 治疗，1 次 / 周，总疗程为 8 周。采用贝克抑郁自评量表（BDI）、贝克焦虑自评量表（BAI）和心理弹性量表（CD-RISC） 对两组患儿治疗前、治疗 4 周后、治疗 8 周后的心理情况进行评价。
结果
研究过程中存在 5 例脱落病例，最终完成 试验 55 例，其中舍曲林治疗组 28 例，EMDR 治疗组 27 例。时间和组间对两组患儿 BDI、BAI、CD-RISC 评分存在交 互作用（P<0.05）；时间对两组患儿 BDI、BAI、CD-RISC 评分主效应显著（P<0.05）；组间对两组患儿 BAI、CDRISC 评分主效应显著（P<0.05）；组间对 BDI 评分主效应不显著（P>0.05）。治疗 4 周后 EMDR 治疗组患儿 CDRISC 评分高于舍曲林治疗组（P<0.05）。治疗 8 周后 EMDR 治疗组患儿 CDRI-SC 评分高于舍曲林治疗组，BDI、BAI 评 分低于舍曲林治疗组（P<0.05）。舍曲林治疗组患儿治疗 8 周后 BDI 评分低于治疗前、治疗 4 周后（P<0.05）；舍曲 林治疗组患儿治疗 8 周后 BAI 评分低于治疗 4 周后（P<0.05）。EMDR 治疗组患儿治疗 4、8 周后 BDI、BAI 评分均低 于治疗前，CD-RISC 评分高于治疗前（P<0.05）；EMDR 治疗组患儿 8 周后 BDI、BAI 评分均低于治疗 4 周后，CDRISC 评分高于治疗 4 周后（P<0.05）。
结论
舍曲林能部分改善伴童年创伤的青少年抑郁症患儿的抑郁和焦虑情绪， 但对于心理弹性的提升效果不显著；EMDR 不仅能够有效改善伴童年创伤抑郁症患儿的抑郁和焦虑情绪，还能提升心 理弹性，可作为其优选治疗方案。
Background
Depressed adolescents with childhood trauma often present with more severe symptoms and are insensitive to drugs. Eye movement desensitization and reprocessing （EMDR） plays a unique role in the treatment of trauma-related mental disorders. It has been gradually used in the treatment of depression and has achieved certain results recently，but there are few related studies in China.
Objective
To assess whether EMDR has better efficacy than sertraline in the treatment of depressed adolescents with childhood trauma using a comparative analysis，providing scientific evidence for further promoting clinical application of EMDR.
Methods
Sixty depressed adolescents with childhood trauma were recruited from Psychological Clinic，Affiliated Hospital of Zunyi Medical University from December 2020 to February 2022, and equally randomized into a sertraline group and an EMDR group. Sertraline group received a eight-week treatment with sertraline：the dose was 50 mg/d in the first week and gradually increased to 100 mg/d in the second week，and could be increased to 200 mg/d at the end of the fourth week if the patients had negative ideas or self-injurious behavior. The EMDR group received EMDR treatment, once a week，for a total of 8 weeks. The Beck Depression Inventory（BDI)，Beck Anxiety Inventory (BAI）and Connor-Davidson Resilience Scale （CD-RISC）were used to evaluate the psychological status of the two groups before treatment, four weeks and eight weeks after treatment.
Results
Except for five dropouts，the remaining cases who completed the trial were finally included，including 28 in the sertraline group and 27 in the EMDR group. The treatment type and treatment duration had interactive effects on the BDI，BAI and CD-RISC scores of the two groups（P<0.05). The treatment duration had significant main effects on the BDI，BAI and CD-RISC scores of the two groups（P<0.05). The treatment type had significant main effects on BAI and CD-RISC scores of the two groups （P<0.05)，but produced no significant effects on the BDI scores （P>0.05). EMDR group had higher average CDRI-SC score than sertraline group at four weeks after treatment（P<0.05). EMDR group had higher average CDRI-SC score，and lower average BDI and BAI scores than sertraline group at eight weeks after treatment （P<0.05). In the sertraline group，the average BDI score at eight weeks after treatment was much lower than that at baseline or four weeks after treatment （P<0.05)，and the average BAI score at eight weeks after treatment was much lower than that at four weeks of treatment（P<0.05). In the EMDR group，the average BDI and BAI scores decreased significantly while the average CD-RISC score increased significantly at both four and eight weeks after treatment compared with baseline levels （P<0.05）. And compared with four-week treatment，eight-week treatment lowered the average BDI and BAI scores more significantly，and increased the average CD-RISC score more significantly（P<0.05).
Conclusion
Sertraline could partially improve depression and anxiety in depressed adolescents with childhood trauma，but had no significant improvement of psychological elasticity. In contrast，EMDR could effectively improve the depression and anxiety as well as psychological elasticity，so it could be used as the preferred treatment.
Format
Journal
Language
Chinese
Original Work Citation
Hu, S., Ou, W., Wang, Z., & Peng, J. (2022). [Eye movement desensitization and reprocessing versus sertraline in the treatment of depressed adolescents with childhood trauma]. China National Science and Medicine. doi:10.12114/j.issn.1007-9572.2022.0650. Chinese
Citation
“眼动脱敏与再加工和舍曲林治疗伴童年创伤的 青少年抑郁症的效果比较Eye movement desensitization and reprocessing versus sertraline in the treatment of depressed adolescents with childhood trauma,” Francine Shapiro Library, accessed May 5, 2024, https://francineshapirolibrary.omeka.net/items/show/27769.